|Title:||Radiofrequency catheter ablation of atrial tachyarrhythmias in adults with repaired congenital heart disease: Constraints from multiple and new arrhythmic foci||Authors:||SHUENN-NAN CHIU
|Issue Date:||2013||Journal Volume:||29||Journal Issue:||4||Start page/Pages:||347-356||Source:||Acta Cardiologica Sinica||Abstract:||
Background: Radiofrequency catheter ablation (RFCA) for atrial tachyarrhythmias in postoperative congenital heart disease (CHD) patients has a low success rate and a high recurrence rate. This study explores the reasons for these constraints. Methods: A total of 49 consecutive postoperative CHD patients who received RFCA for atrial tachyarrhythmias between 1993 and 2010 were enrolled. Results: Overall, there were 86 RFCA procedures performed, 32 with the conventional method and 54 using CARTO-guided mapping. The interval between the operation and the first ablation was 13 years. Isthmusdependent atrial flutter (AFL)was the most common type of tachycardia (37, 76%), followed by intra-atrial re-entry tachycardia (IART; 37%), and ectopic atrial tachycardia (EAT; 31%). By applying CARTO-guided mapping, the success ratewas elevated compared to that of conventional ablation (84% vs. 56%, p = 0.006), but therewas no improvement in the recurrence rate (22% vs. 28%, p = 0.75).Multiple atrial tachyarrhythmias occurred in 26 (53%) patients, and 17 presented during the initial electrophysiological study. The presence of multiple arrhythmias during the initial study predicted ablation failure or multiple ablations (11/17 vs. 3/32, p < 0.001). Among the 15 patients with new tachyarrhythmias, EAT and IART predominated. However, applying antiarrhythmia agents immediately following ablation may decrease arrhythmia recurrence (1/10 vs. 14/25, p = 0.02). Conclusions: Although electroanatomical mapping improves the results of RFCA in atrial tachyarrhythmias, the recurrence rate remains high because of multiple and new atrial tachyarrhythmias. Therefore, short-term pharmacological treatment following RFCA for positive remodeling should be considered.
|ISSN:||1011-6842||SDG/Keyword:||adolescent; adult; aged; article; catheter ablation; child; clinical article; congenital heart disease; controlled study; ectopic atrial tachycardia; electrophysiology; female; heart atrium arrhythmia; heart atrium flutter; heart surgery; human; infant; intermethod comparison; intra atrial re entry tachycardia; male; multiple atrial tachyarrhythmias; outcome assessment; postoperative care; preschool child; recurrence risk; school child; treatment failure; treatment outcome
|Appears in Collections:||醫學系|
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