Catheter ablation of intra-atrial re-entrant tachycardia in adult congenital heart disease: Value of final programmed atrial stimulation

Abstract

While outcomes of intra-atrial re-entrant tachycardia (IART) catheter ablation have considerably improved in adult congenital heart disease (ACHD), recurrences remain common with different circuits frequently encountered. We aimed to assess the value of programmed atrial stimulation after successful clinical IART catheter ablation in ACHD patients. Retrospective study including all ACHD patients undergoing IART catheter ablation in a large tertiary centre. After successful catheter ablation of the clinical arrhythmia, survival free from arrhythmia recurrence was analysed according to whether all inducible IART were targeted. From 2004 to 2020, 238 IART catheter ablations were performed (mean age 44.1 ± 15.0 years, 61.3% males). Acute procedural success of clinical arrhythmia was achieved in 208 (87.4%) procedures. Among 122 (58.7%) patients with programmed atrial stimulation, at least one other IART was induced in 61 (50%) patients. All inducible IART were ablated in 54 (88.5%) patients whereas 7 (11.5%) patients had at least one non-targeted inducible IART. Patients with non-targeted inducible IART had a higher risk of atrial arrhythmia recurrence compared to inducible patients with ablation of all IART (HR = 5.7, 95% CI: 1.7–18.4), with 12-month survival rates of 22.9% and 77.7%, respectively. Inducible patients with successful ablation of all IART had a similar risk of atrial arrhythmia recurrence compared to non-inducible patients (HR = 0.6, 95% CI: 0.3–1.3) ( Fig. 1 ). Our findings suggest that final programmed atrial stimulation is associated with improved outcomes in ACHD patients referred for IART ablation when all inducible IART are targeted and successfully ablated.