Reablation of Arrhythmias in Patients with Complex Congenital Heart Disease: Recurrence or New Arrhythmia?

Background: Although there are some technical improvements in the catheter ablation, it is very difficult to provide completely arrhythmia-free life to the patients with complex CHD. Here, we describe our experience of catheter reablation by using a multipolar grid-patterned mapping catheter in patients with complex CHD.

Method: The cardiac electrophysiological and electroanatomical data of patients from the initial ablation and reablation of atrial tachycardia by using multipolar grid-patterned high density mapping catheter between April 2018 and August 2022 were analyzed offline.

Results: A total of 37 consecutive patients with atrial tachycardia (mean age 34.2 ± 33.0 years) underwent catheter ablation procedures by using high density mapping catheter. The underlying heart defects were s/p ASD-closure (n = 2), ASD-closure and corrected partial anomalous pulmonary venous return (n = 2), corrected unroofed coronary sinus (n = 1), pulmonary valve commissurotomy (n = 2), repaired Tetralogy of Fallot (n = 2), tricuspid and pulmonary valve replacement in PA/IVS (n = 1), mitral valve replacement (n = 1), Hypoplastic right heart syndrome (n = 1), atrial switch procedure for dTGA (n = 7), TA with Glenn shunt (n = 1), Ross operation (n = 1), Fontan palliation (n = 16). 8 reablation in 6/37 patients (median age: 29.7 ± 4.7 years, female n = 4) were performed after the initial ablation. 4/6 patients with reablation had Fontan palliation and catheter reablation was performed twice in 2 patients. Procedural features in the first and reablation are as followed: the total collected points and used points (mean): 32,657 ± 46,171 vs. 20,897 ± 15,594 and 3,851 ± 3,295 vs. 2,826 ± 1,850 (p > 0.05); mean mapping and fluoroscopy time: 62.1 ± 40.7 vs. 72.6 ± 36.5 minutes and 11.4 ± 8.5 vs. 17.9 ± 13.4 minutes (p > 0.05); total number of substrate: 69 vs. 15; acute success: 94.2% (65/69) vs. 86.6% (13/15); follow-up (median): 35 (range: 11–56) vs 24,5 months (range: 7–46); reablation rate: 16.2% (6/37 patients). All substrates during the reablation were new tachycardia substrates. Comparison of the data of first ablation and reablation showed no significant difference in terms of demographic and procedural features.

Conclusion: Although we have high acute success rate of atrial tachycardia ablation and no recurrence in our cohort, it should be definitely considered that new tachycardia substrates are not uncommon in complex CHD patients and these patients should be followed carefully in terms of symptoms and evidence of arrhythmia.

Publication History

Article published online:
28 January 2023