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  • Title: Outcomes of radiofrequency catheter ablation of atrioventricular reciprocating tachycardia in patients with congenital heart disease.
    Author: Chetaille P, Walsh EP, Triedman JK.
    Journal: Heart Rhythm; 2004 Jul; 1(2):168-73. PubMed ID: 15851148.
    Abstract:
    OBJECTIVES: Assessment of clinical outcomes of catheter ablation of atrioventricular reciprocating tachycardias in patients with congenital heart disease (CHD). BACKGROUND: Atrioventricular reciprocating tachycardias occur in patients with CHD and may be poorly tolerated. METHODS: Retrospective review of all 105 such ablations in 83 patients performed between 03/90 and 02/02 at one institution. RESULTS: The dominant arrhythmia mechanism was accessory pathway (70 patients, 84%), and the most common indications were drug-refractory tachycardia, life-threatening arrhythmia, and elective presurgical ablation. Congenital heart disease diagnoses were diverse, with one third of patients having Ebstein's anomaly. Twenty patients (24%) had catheter access limited by prior surgeries or occluded vascular access. Of 109 accessory pathways (APs), 74 (68%) were manifestly preexcited, and 71 (65%) were located on the right atrioventricular groove. Fourteen patients (20%) had multiple pathways. There were 2 major complications (1 death, 1 hemorrhage), and 3 minor complications (5.5% of procedures). Acute success rate was 80% per procedure, 82% for left- and 70% for right-sided APs. Acute success rates for patients with Ebstein's anomaly were similar to patients with other CHD diagnoses, but Ebstein's patients were more likely to have recurrence. At 44 +/- 35 months follow-up, successful ablation was achieved in 59% of procedures and 68% of patients, with 19 patients (23%) undergoing one or more repeat ablations. CONCLUSIONS: Compared to patients with normal cardiac anatomy, patients with CHD of all varieties have lower rates of acute and long-term success for ablation for atrioventricular reciprocating tachycardias.
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