Outcomes of radiofrequency catheter ablation of atrioventricular reciprocating tachycardia in patients with congenital heart disease

Abstract

Objectives Assessment of clinical outcomes of catheter ablation of atrioventricular reciprocating tachycardias in patients with congenital heart disease (CHD). Background Atrioventricular reciprocating tachycardias occur in patients with CHD and may be poorly tolerated. Methods Retrospective review of all 105 such ablations in 83 patients performed between 03/90 and 02/02 at one institution. Results The dominant arrhythmia mechanism was accessory pathway (70 patients, 84%), and the most common indications were drug-refractory tachycardia, life-threatening arrhythmia, and elective presurgical ablation. Congenital heart disease diagnoses were diverse, with one third of patients having Ebstein’s anomaly. Twenty patients (24%) had catheter access limited by prior surgeries or occluded vascular access. Of 109 accessory pathways (APs), 74 (68%) were manifestly preexcited, and 71 (65%) were located on the right atrioventricular groove. Fourteen patients (20%) had multiple pathways. There were 2 major complications (1 death, 1 hemorrhage), and 3 minor complications (5.5% of procedures). Acute success rate was 80% per procedure, 82% for left- and 70% for right-sided APs. Acute success rates for patients with Ebstein’s anomaly were similar to patients with other CHD diagnoses, but Ebstein’s patients were more likely to have recurrence. At 44 ± 35 months follow-up, successful ablation was achieved in 59% of procedures and 68% of patients, with 19 patients (23%) undergoing one or more repeat ablations. Conclusions Compared to patients with normal cardiac anatomy, patients with CHD of all varieties have lower rates of acute and long-term success for ablation for atrioventricular reciprocating tachycardias.