B-PO03-202 ABLATION OF ATRIAL FIBRILLATION AND FLUTTER IN ADULT CONGENITAL HEART DISEASE: PROCEDURAL ASPECTS AND OUTCOMES

Abstract

Patients with ACHD have increased risk of arrhythmia due to underlying condition and prior surgeries. To assess ablation success of atrial fibrillation and flutter in ACHD. All ACHD patients who underwent EP ablation for atrial fibrillation or flutter from 12/2013 to 11/2020 were included, for a total of 46 subjects and 58 ablations. Median age was 58.0 (IQR = 41.0 - 68.0), 67.4% were male and 80.4% had prior corrective surgery. Prior to ablation, 67.4% failed an average of 1.39 antiarrhythmic drugs (AAD). Of the 58 ablations performed, 22 (37.3%) had atrial fibrillation, 21 (35.6%) had atrial flutter and 16 (27.1%) had both. At the end of procedure, acute success rate was 81.1%, with 18.9% requiring cardioversion. Twelve patients had second ablation, with total recurrence rate of 41.3%, at follow up of 38.7 +/- 23.4 months. Rate of recurrence was not significantly different among patients who had atrial fibrillation, flutter or both (χ2 = .804, p = .669). Recurrence predictors (by logistic regression) revealed use of smart touch catheter with lower rate of arrhythmia recurrence (OR = .0702, p = .014) and DCCV with higher rate (OR = 4.50, p = .027). Multielectrode mapping decreased mean RF time by 1,130 seconds (t = 2.19, p = .0338). One year after ablation, 17.4% of subjects were on AAD, for a 74.2% decrease (z = 4.56, p < .001). Four (8.7%) subjects died during the study period, ranging 103 to 1260 days after ablation. Four (8.7%) subjects required pacemaker. Atrial arrhythmia ablation is safe and recommended in patients with ACHD, reducing need for AAD. Successful ablation without arrhythmia recurrence remains a challenge.