Contemporary Patients With Congenital Heart Disease: Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome

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Contemporary Patients With Congenital Heart Disease : Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome. / Brouwer, Charlotte; Hebe, Joachim; Lukac, Peter et al.

I: Circulation. Arrhythmia and Electrophysiology, Bind 14, Nr. 9, 009695, 09.2021.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

Harvard

Brouwer, C, Hebe, J, Lukac, P, Nürnberg, J-H, Nielsen, JC, Riva, MD, Blom, N, Hazekamp, M & Zeppenfeld, K 2021, 'Contemporary Patients With Congenital Heart Disease: Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome', Circulation. Arrhythmia and Electrophysiology, bind 14, nr. 9, 009695. https://doi.org/10.1161/CIRCEP.120.009695

APA

Brouwer, C., Hebe, J., Lukac, P., Nürnberg, J-H., Nielsen, J. C., Riva, M. D., Blom, N., Hazekamp, M., & Zeppenfeld, K. (2021). Contemporary Patients With Congenital Heart Disease: Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome. Circulation. Arrhythmia and Electrophysiology, 14(9), [009695]. https://doi.org/10.1161/CIRCEP.120.009695

CBE

Brouwer C, Hebe J, Lukac P, Nürnberg J-H, Nielsen JC, Riva MD, Blom N, Hazekamp M, Zeppenfeld K. 2021. Contemporary Patients With Congenital Heart Disease: Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome. Circulation. Arrhythmia and Electrophysiology. 14(9):Article 009695. https://doi.org/10.1161/CIRCEP.120.009695

MLA

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Author

Brouwer, Charlotte ; Hebe, Joachim ; Lukac, Peter et al. / Contemporary Patients With Congenital Heart Disease : Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome. I: Circulation. Arrhythmia and Electrophysiology. 2021 ; Bind 14, Nr. 9.

Bibtex

@article{610fc7545fdb4bcd9a160fa8a68c18c1,
title = "Contemporary Patients With Congenital Heart Disease: Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome",
abstract = "BACKGROUND: Poor outcome after atrial tachycardia (AT) radiofrequency catheter ablation (RFCA) in repaired congenital heart disease (CHD) has been attributed to CHD complexity. This may not apply to contemporary patients. The objective of our study was to assess outcome after RFCA for AT in contemporary patients with CHD according to prior atrial surgery and predefined procedural end points.METHODS: Patients with CHD referred for AT RFCA to 3 European centers were classified as no atrial surgery/cannulation only, limited or extensive prior atrial surgery. Procedural success was predefined as termination and nonreinducibility for focal AT and bidirectional block across ablation lines for intra-atrial reentrant tachycardia and after empirical substrate ablation for noninducible patients. Patients were followed for AT recurrence and mortality.RESULTS: Ablation was performed in 290 patients (41±17 years, 59% male; 3-dimensional mapping 89%, irrigated tip catheters 90%, transbaffle access 15%). In 197, 233 AT were targeted (196 intra-atrial reentrant tachycardia [64% cavotricuspid (mitral) isthmus-dependent, 33% systemic-venous incision-dependent] and 37 focal AT). In 93 noninducible patients, empirical substrate ablation was performed. Procedural success was achieved in 209 (84%) patients. AT recurred in 148 (54%) 10 (interquartile range, 0-25) months after RFCA. AT-free survival was significantly better in patients with no atrial repair/cannulation only and in patients with complete procedural success independently of CHD complexity. From 94 patients undergoing reablation, the initially targeted substrate had recovered in 64%.CONCLUSIONS: In contemporary patients with CHD, outcome after AT ablation is associated with presence of prior atrial surgery and achievement of predefined procedural end points rather than CHD complexity. Techniques to improve lesion durability are likely to further improve long-term outcome.",
keywords = "ADULTS, ARRHYTHMIAS, CATHETER ABLATION, D-TRANSPOSITION, EXPERT CONSENSUS STATEMENT, INTRAATRIAL REENTRANT TACHYCARDIA, PREDICTORS, SUPRAVENTRICULAR TACHYCARDIA, SURGICAL REPAIR, TACHYARRHYTHMIAS, catheter ablation, congenital heart disease, mortality, tachycardia",
author = "Charlotte Brouwer and Joachim Hebe and Peter Lukac and Jan-Hendrik N{\"u}rnberg and Nielsen, {Jens Cosedis} and Riva, {M de} and Nico Blom and Mark Hazekamp and Katja Zeppenfeld",
year = "2021",
month = sep,
doi = "10.1161/CIRCEP.120.009695",
language = "English",
volume = "14",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "9",

}

RIS

TY - JOUR

T1 - Contemporary Patients With Congenital Heart Disease

T2 - Uniform Atrial Tachycardia Substrates Allow for Clear Ablation End Points With Improved Long-Term Outcome

AU - Brouwer, Charlotte

AU - Hebe, Joachim

AU - Lukac, Peter

AU - Nürnberg, Jan-Hendrik

AU - Nielsen, Jens Cosedis

AU - Riva, M de

AU - Blom, Nico

AU - Hazekamp, Mark

AU - Zeppenfeld, Katja

PY - 2021/9

Y1 - 2021/9

N2 - BACKGROUND: Poor outcome after atrial tachycardia (AT) radiofrequency catheter ablation (RFCA) in repaired congenital heart disease (CHD) has been attributed to CHD complexity. This may not apply to contemporary patients. The objective of our study was to assess outcome after RFCA for AT in contemporary patients with CHD according to prior atrial surgery and predefined procedural end points.METHODS: Patients with CHD referred for AT RFCA to 3 European centers were classified as no atrial surgery/cannulation only, limited or extensive prior atrial surgery. Procedural success was predefined as termination and nonreinducibility for focal AT and bidirectional block across ablation lines for intra-atrial reentrant tachycardia and after empirical substrate ablation for noninducible patients. Patients were followed for AT recurrence and mortality.RESULTS: Ablation was performed in 290 patients (41±17 years, 59% male; 3-dimensional mapping 89%, irrigated tip catheters 90%, transbaffle access 15%). In 197, 233 AT were targeted (196 intra-atrial reentrant tachycardia [64% cavotricuspid (mitral) isthmus-dependent, 33% systemic-venous incision-dependent] and 37 focal AT). In 93 noninducible patients, empirical substrate ablation was performed. Procedural success was achieved in 209 (84%) patients. AT recurred in 148 (54%) 10 (interquartile range, 0-25) months after RFCA. AT-free survival was significantly better in patients with no atrial repair/cannulation only and in patients with complete procedural success independently of CHD complexity. From 94 patients undergoing reablation, the initially targeted substrate had recovered in 64%.CONCLUSIONS: In contemporary patients with CHD, outcome after AT ablation is associated with presence of prior atrial surgery and achievement of predefined procedural end points rather than CHD complexity. Techniques to improve lesion durability are likely to further improve long-term outcome.

AB - BACKGROUND: Poor outcome after atrial tachycardia (AT) radiofrequency catheter ablation (RFCA) in repaired congenital heart disease (CHD) has been attributed to CHD complexity. This may not apply to contemporary patients. The objective of our study was to assess outcome after RFCA for AT in contemporary patients with CHD according to prior atrial surgery and predefined procedural end points.METHODS: Patients with CHD referred for AT RFCA to 3 European centers were classified as no atrial surgery/cannulation only, limited or extensive prior atrial surgery. Procedural success was predefined as termination and nonreinducibility for focal AT and bidirectional block across ablation lines for intra-atrial reentrant tachycardia and after empirical substrate ablation for noninducible patients. Patients were followed for AT recurrence and mortality.RESULTS: Ablation was performed in 290 patients (41±17 years, 59% male; 3-dimensional mapping 89%, irrigated tip catheters 90%, transbaffle access 15%). In 197, 233 AT were targeted (196 intra-atrial reentrant tachycardia [64% cavotricuspid (mitral) isthmus-dependent, 33% systemic-venous incision-dependent] and 37 focal AT). In 93 noninducible patients, empirical substrate ablation was performed. Procedural success was achieved in 209 (84%) patients. AT recurred in 148 (54%) 10 (interquartile range, 0-25) months after RFCA. AT-free survival was significantly better in patients with no atrial repair/cannulation only and in patients with complete procedural success independently of CHD complexity. From 94 patients undergoing reablation, the initially targeted substrate had recovered in 64%.CONCLUSIONS: In contemporary patients with CHD, outcome after AT ablation is associated with presence of prior atrial surgery and achievement of predefined procedural end points rather than CHD complexity. Techniques to improve lesion durability are likely to further improve long-term outcome.

KW - ADULTS

KW - ARRHYTHMIAS

KW - CATHETER ABLATION

KW - D-TRANSPOSITION

KW - EXPERT CONSENSUS STATEMENT

KW - INTRAATRIAL REENTRANT TACHYCARDIA

KW - PREDICTORS

KW - SUPRAVENTRICULAR TACHYCARDIA

KW - SURGICAL REPAIR

KW - TACHYARRHYTHMIAS

KW - catheter ablation

KW - congenital heart disease

KW - mortality

KW - tachycardia

U2 - 10.1161/CIRCEP.120.009695

DO - 10.1161/CIRCEP.120.009695

M3 - Journal article

C2 - 34465129

VL - 14

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 9

M1 - 009695

ER -