Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2010 Nov 2;56(19):1589-96. doi: 10.1016/j.jacc.2010.04.061.
The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for intra-atrial re-entrant tachycardia (IART) in adults with congenital heart disease (CHD), and predictors of these outcomes.
Atrial myopathy can be progressive in CHD and contributes to the substrate for IART. Although the outcome of RFCA for IART has been well described in children and adolescents with CHD, it is unclear whether these results are similar in the adult population.
Clinical records of adults with CHD undergoing attempted RFCA of IART were analyzed retrospectively. Multivariate analyses identified clinical and procedural factors that predicted acute and long-term outcomes.
A total of 193 procedures was performed in 130 patients (mean age 40 ± 13 years); 82 of 118 (69%) initially attempted RFCA were successful, defined as termination of all IART circuits. The use of electroanatomic mapping was associated with a successful RFCA, whereas Fontan palliation and Mustard repair were associated with an unsuccessful RFCA. Median clinical follow-up of 77 patients (≥2 months of follow-up) after a successful RFCA was 3.7 years (range 0.2 to 10.2 years). IART recurrence was noted in 48%, cardioversion/reablation in 42%, and death in 4%. Older age and Fontan palliation were independent predictors of IART recurrence.
In adults with CHD, acute and long-term outcomes of RFCA for IART are similar to those reported for younger cohorts. Complex atrial surgery limits the success of RFCA, and older age is associated with a higher risk of IART recurrence.
本研究旨在确定射频导管消融（RFCA）治疗成人先天性心脏病（CHD）患者房内折返性心动过速（IART）的即刻和长期疗效，以及这些疗效的预测因素。
CHD 患者的心房肌病可能呈进行性发展，为 IART 的发生提供了基质。尽管 RFCA 治疗 CHD 儿童和青少年 IART 的疗效已有相关报道，但尚不清楚这些结果是否适用于成年人群。
回顾性分析了 130 例接受 IART 尝试 RFCA 的 CHD 成人患者的临床记录。多变量分析确定了预测即刻和长期疗效的临床和手术因素。
共对 130 例患者的 193 次手术进行了分析（平均年龄 40 ± 13 岁）；118 次初始 RFCA 中有 82 次（69%）成功，定义为所有 IART 环的终止。使用电生理标测与 RFCA 成功相关，而 Fontan 姑息术和 Mustard 修复术与 RFCA 失败相关。82 次成功 RFCA 后 77 例患者（≥2 个月的随访）的中位临床随访时间为 3.7 年（范围 0.2 至 10.2 年）。48%的患者出现 IART 复发，42%的患者需要电复律/再消融，4%的患者死亡。年龄较大和 Fontan 姑息术是 IART 复发的独立预测因素。
在 CHD 成人患者中，RFCA 治疗 IART 的即刻和长期疗效与年轻患者相似。复杂的心房手术限制了 RFCA 的成功率，年龄较大与更高的 IART 复发风险相关。
