Very Long-term Course after Ablation of Cardiac Arrhythmias in Children and Adults with Congenital Heart Disease—A Single-center Experience

Background: Catheter ablation (CA) is an established and successful therapy in patients with congenital heart disease (CHD). Currently, there are no data on very long-term follow-up of CA of cardiac arrhythmia in CHD patients assessing the factors influencing the success of ablation. The aim of our study was to determine the success rate of initial and re-ablations and to identify factors influencing ablations’ success.

Methods: This retrospective study includes 166 patients who underwent CA at the Heart and Diabetes Centre in North Rhine-Westphalia between 2009 and 2020. Using Warnes’ criteria, the patients were divided into three groups according to the severity of their CHD. The recurrences after the initial and subsequent ablations, as well as the procedure data and the patient characteristics, were recorded and evaluated.

Results: The tachycardia recurrence after initial ablation was 60.6%. The mean tachycardia-free survival was 1,056.59 days (2–5,416 days) and the estimated survival without tachycardia was 1,908.31 days. Re-ablations reduced the recurrence rate of tachycardia to 28.9% and increased survival without tachycardia to 2,688.77 days (p < 0.001). Factors associated with recurrent tachycardia were older age at ablation, longer procedure or fluoroscopy time, female sex, electrical cardioversion before ablation, heart failure, pacemaker (PM), and use of amiodarone. Patients taking ASA were less likely to experience recurrent tachycardia. We were able to show a difference in tachycardia-free survival among the three different populations of severity of CHD. However, this difference was not statistically significant. In all populations, further ablations led to a longer tachycardia-free survival. The difference was statistically significant for patients with intra-atrial reentry tachycardia (IART), AVNRT, and AVRT. The ablation of atrial fibrillation was preferentially performed as pulmonary vein isolation with a recurrence rate of 62.9% within medium 570 days.

Conclusion: CA in patients with CHD shows good primary ablation success. However, recurrent tachycardia in CHD patients is common. Multiple ablations for patients with IART, AVNRT, and AVRT can significantly improve tachycardia-free survival. In contrast, ablation and re-ablation of atrial fibrillation only showed limited success. Therefore, ablation of atrial fibrillation, especially in patients with moderate and severe CHD should be critically indicated. Regarding the fact that many patients reject further re-ablation despite tachycardia recurrence, we should reconsider the definition of successful ablation, especially in terms of quality of life.

Publication History

Article published online:
11 February 2025