Catheter Ablation of Atrial Reentry Tachycardia in Patients with Congenital Heart Disease—Efficacy and Safety

Prevalence of atrial reentry tachycardia (ART) in patients with congenital heart disease (CHD) is associated with increased morbidity and mortality. Besides antiarrhythmic medication, catheter ablation has become the treatment of choice. Data on ART ablation in these patients is sparse. We conducted a single center study on efficacy and safety.

In 128 patients 197 ablation procedures were performed between 01/2003 and 11/2014. Median age at the first procedure was 32.4 (range 1.3–70) years. Mapping was performed with non-contact or contact mapping systems. Radiofrequency current was delivered with irrigated tip catheters (7 F, 4 mm tip) in a temperature control mode (45°C, 30–50 W, 45 seconds).

After the first procedure, acute success was 78.1%. 45 patients underwent multiple ablation procedures. Follow up data were available from 118 patients. 76 patients (64.4%) were free from ART recurrence over a median of 21.5 (range 1–123) months. Median fluoroscopy time was 22.1 minute and median procedure duration was 260 minute. Major complications occurred in 4 patients. In 3 patients groin vessel damage required surgical revision. In one patient, stenosis of the right coronary artery after cavotricuspid isthmus ablation required stent implantation. There was no death and no permanent AV block. Complication rate was not related to age or complexity of CHD.

Overall success of catheter ablation of ART in patients with CHD was 78.1% and was lower when compared with patients without CHD. A substantial number of patients needed additional procedures. Ablation procedures were safe with a low complication rate. New technologies as contact force measurement may increase efficacy of catheter ablation in this population.