Background

Modern surgery and medical treatment has lead to improved mortality of patients (pts) with congenital heart disease (CHD).  More than 90% of pts with CHD reach adulthood bringing up late complications, especially heart failure and arrhythmias.

Objectives

Interventional treatment of arrhythmias in adults with CHD (ACHD) is challenging due to the complex changes in anatomy in CHD pts. We report our single center experience of catheter ablation (CA) in ACHD.

Methods

Data of consecutive pts undergoing CA of supraventricular or ventricular arrhythmia between 03/2017 and 03/2020 was analyzed. Follow up visits were performed at 3, 6 and 12 months after CA.

Results

We included 30 consecutive ACHD pts (47.3 ± 11.7, 55% female). Mean FU was 9.8 ± 3.2 months. Atrial septal defect (ASD) was present in 13 pts, 9 corrected surgically, 4 interventionally. Furthermore, Ebstein’s anomalia in 6 cases, 4 pts with Tetralogy of Fallot and one case respectively of transposition of great arteries, Marfan syndrome, atresia of inferior caval vein (ICV) and situs inversus totalis with dextrocardia and common atrium.

Most frequent indication for CA was atrial fibrillation (AF) and atrial tachykardia (AT). In 10 pts pulmonary vein isolation (PVI) alone, in 4 pts PVI with cavotricuspid isthmus (CTI) ablation and in 6 pts PVI and AT ablation was performed.

4 pts underwent Ablation of ventricular tachycardia (VT), 3 pts PVC ablation and in 3 pts CTI and slow-pathway ablation was performed. In simple and moderate cases of CHD no additional imaging was applied. Transseptal puncture after ASD occlusion was performed echo-guided. In pts with severe CHD additional MRI or CT scans for pre-procedural assessment were used. Epicardial PVI was performed in the case of ICV atresia. In the majority of cases (92%) a 3D mapping system was applied. Acute success was achieved in 96%. Only in case of a septal AT in a patient with dextrocardia and situs inversus AT termination could not be achieved due to increased risk of AV-block. No complications occurred. After 6 months of follow up 76% were arrhythmia free. In 5 cases of AF and AT and 1 pts with VTs a second procedure was performed during FU.   

Conclusion

Catheter ablation is a safe and effective treatment for arrhythmias in CHD pts. In simple and moderate cases additional imaging is abdicable but especially for severe cases MRI and CT scans, image integration, 3D mapping and long-term planning of ablation procedures are crucial.