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The Role of Atrial Arrhythmia Ablation in Adolescent and Adult Congenital Heart Disease

  • Arrhythmias (J. Bunch, Section Editor)
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Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Atrial arrhythmias cause significant morbidity in patients with congenital heart disease (CHD). Catheter ablation remains one of the most effective treatment modalities for atrial arrhythmias. However, patients with congenital heart disease present unique challenges for catheter ablation.

Recent Findings

Recent expert consensus guidelines inform physicians about treating arrhythmias in patients with CHD. These guidelines outline appropriate selection criteria for ablation and highlight treatment alternatives. The authors also suggest electrophysiology laboratory and physician standards for performing these complex procedures. Recent studies report that 51% of atrial arrhythmias in CHD involve the cavo-tricuspid isthmus (CTI), 28% were non-CTI related and two types of IART were present in 21%. These studies link recurrence of tachycardia after ablation to CHD complexity, non-CTI-related arrhythmias, and patients with prolonged intra-atrial conduction. An analysis of patients with displaced AV nodes showed that cryoablation is a safe and effective technology to perform ablation in CHD with perinodal substrates. Changes in surgical Fontan palliation away from intracardiac baffles to extracardiac conduit has hopefully decreased arrhythmia burden in single ventricle patients. However, in those with atrial arrhythmias, access to the atria is complicated by no direct systemic venous access to the heart. Recent single-center and multicenter studies evaluated the success of ablation in these patients and outline safe approaches to transbaffle puncture. Acute success was 83% with similar complication profile to other CHD patients.

Summary

The anatomic variations of congenital heart disease create special problems for catheter ablation. Teams performing ablation need pre-procedural preparation and specialized understanding of a vast anatomic variation and surgical repairs. This understanding coupled with the knowledge of the pathophysiology of arrhythmia disorders and the biophysics of catheter ablation technology is required to perform successful and safe ablation procedures.

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  1. Division of Pediatric Cardiology, University of Utah, Located at Primary Children’s Hospital, 81 N. Mario Capecchi Dr, Salt Lake City, UT, 84113, USA

    Thomas A. Pilcher

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Pilcher, T.A. The Role of Atrial Arrhythmia Ablation in Adolescent and Adult Congenital Heart Disease. Curr Cardiovasc Risk Rep 13, 5 (2019). https://doi.org/10.1007/s12170-019-0600-6

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