TY - JOUR
T1 - Catheter ablation of supraventricular tachycardia after tricuspid valve surgery in patients with congenital heart disease
T2 - A multicenter comparative study
AU - Moore, Jeremy P.
AU - Gallotti, Roberto G.
AU - Chiriac, Anca
AU - McLeod, Christopher J.
AU - Stephenson, Elizabeth A.
AU - Maghrabi, Khadijah
AU - Fish, Frank A.
AU - Kilinc, Orhan U.
AU - Bradley, David
AU - Krause, Ulrich
AU - Balaji, Seshadri
AU - Shannon, Kevin M.
N1 - Publisher Copyright:
© 2019
PY - 2020/1
Y1 - 2020/1
N2 - Background: Tricuspid valve (TV) surgery is often required for adult congenital heart disease (ACHD), but may hinder catheter ablation when an artificial material or imbricated tissue covers the tricuspid annulus. Objective: The purpose of this study was to determine the outcomes of catheter ablation after TV surgery in a large ACHD cohort. Methods: An international retrospective study involving 7 centers was conducted. Patients who did and did not undergo TV surgery were matched for age, lesion classification, and postsurgical duration. TV operations were classified as valve ring/replacement vs repair. Results: One hundred thirty-six patients (42 ring/replacement, 39 repair, and 55 no TV surgery; median 32 years [IQR 20 - 46]) underwent 180 procedures targeting 239 tachycardias (cavotricuspid-isthmus dependent intraatrial reentrant tachycardia 36%, other intraatrial reentrant tachycardia 29%, focal atrial tachycardia 18%, and other supraventricular tachyarrhythmia 17%). Post-TV surgery, procedures were longer (4.3 hours vs 3.3 hours; P = .003) and required longer fluoroscopy time (31 minutes vs 18 minutes; P = .001). At least partial acute success was achieved in 81% of procedures in the TV ring/replacement group vs 94% in both TV repair and no TV surgery groups (P = .03). The difference was driven mainly by ablation of annular substrates, with acute success in 73% of TV ring/replacement, 92% of TV repair, and 94% of no TV surgery groups (P = .01). Over a median of 3.0 years, tachycardia recurred after 26% of procedures. TV ring/replacement predicted recurrence in the multivariable analysis (hazard ratio 2.4; 95% confidence interval 1.2–5.2; P = .009). Conclusion: After surgery for ACHD, catheter ablation success was lower and tachycardia recurrence was higher after TV valve ring/replacement surgery. The findings of this retrospective report support future larger multicenter series and prospective evaluation to determine the role of empirical annular substrate ablation.
AB - Background: Tricuspid valve (TV) surgery is often required for adult congenital heart disease (ACHD), but may hinder catheter ablation when an artificial material or imbricated tissue covers the tricuspid annulus. Objective: The purpose of this study was to determine the outcomes of catheter ablation after TV surgery in a large ACHD cohort. Methods: An international retrospective study involving 7 centers was conducted. Patients who did and did not undergo TV surgery were matched for age, lesion classification, and postsurgical duration. TV operations were classified as valve ring/replacement vs repair. Results: One hundred thirty-six patients (42 ring/replacement, 39 repair, and 55 no TV surgery; median 32 years [IQR 20 - 46]) underwent 180 procedures targeting 239 tachycardias (cavotricuspid-isthmus dependent intraatrial reentrant tachycardia 36%, other intraatrial reentrant tachycardia 29%, focal atrial tachycardia 18%, and other supraventricular tachyarrhythmia 17%). Post-TV surgery, procedures were longer (4.3 hours vs 3.3 hours; P = .003) and required longer fluoroscopy time (31 minutes vs 18 minutes; P = .001). At least partial acute success was achieved in 81% of procedures in the TV ring/replacement group vs 94% in both TV repair and no TV surgery groups (P = .03). The difference was driven mainly by ablation of annular substrates, with acute success in 73% of TV ring/replacement, 92% of TV repair, and 94% of no TV surgery groups (P = .01). Over a median of 3.0 years, tachycardia recurred after 26% of procedures. TV ring/replacement predicted recurrence in the multivariable analysis (hazard ratio 2.4; 95% confidence interval 1.2–5.2; P = .009). Conclusion: After surgery for ACHD, catheter ablation success was lower and tachycardia recurrence was higher after TV valve ring/replacement surgery. The findings of this retrospective report support future larger multicenter series and prospective evaluation to determine the role of empirical annular substrate ablation.
KW - Catheter ablation
KW - Congenital heart disease
KW - Ebstein's anomaly
KW - Ring annuloplasty
KW - Tricuspid valve repair
KW - Tricuspid valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85072205714&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072205714&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2019.07.020
DO - 10.1016/j.hrthm.2019.07.020
M3 - Article
C2 - 31349063
AN - SCOPUS:85072205714
SN - 1547-5271
VL - 17
SP - 58
EP - 65
JO - Heart Rhythm
JF - Heart Rhythm
IS - 1
ER -