Pulmonary vein and left atrial posterior wall isolation for the treatment of atrial fibrillation: Comparable outcomes for adults with congenital heart disease.

Abstract

Optimal treatment strategies for ACHD with AF are unknown. This study sought to assess outcomes of pulmonary vein isolation (PVI) ± left atrial (LA), posterior wall isolation (PWI) for adults with congenital heart disease (ACHD), and atrial fibrillation (AF). A retrospective review of all cryoballoon (CB) PVI ± PWI procedures at a single center over a 3-year period were performed. Clinical characteristics and outcomes for patients with and without ACHD were compared. The primary outcome was the occurrence of atrial tachyarrhythmia at 12-months postablation after a 90-day blanking period. Three-hundred and sixteen patients (mean: 63 ± 12 years, [63% male]) underwent CB PVI ± PWI during the study, including 31 (10%) ACHD (simple 35%, moderate 39%complex 26%; nonparoxysmal AF in 52%). ACHD was younger (51 vs. 64 years;p < .001) with a lower CHADS2 DS2 -VASc score (1.2 vs. 2.1;p = .001) but had a greater LA diameter (4.9 vs. 4.0 cm;p < .001) and a number of prior cardioversions (0.9 vs. 0.4;p < .001) versuscontrols. 12-month freedom from recurrent AF was similar for ACHD and controls (76% vs. 80%;p = .6) and remained nonsignificant in multivariate analysis (hazard ratio:1.8, 95% confidence interval:0.7-5.1; p = .22). At 12-months postablation, 75% of ACHD versus93% of control patients were off antiarrhythmic drug therapy (p = .07). This study demonstrates younger age and lower conventional stroke risk, yet clinically advanced AF for ACHD relative to controls. CB PVI ± PWI was an effective strategy for the treatment of AF among all forms of ACHD with similar 12-month outcomes as compared to controls.