Division of Cardiology, Department of Medicine, UCLA Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
Division of Cardiology, Department of Medicine, UCLA Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
Heart Rhythm. 2020 Jan;17(1):58-65. doi: 10.1016/j.hrthm.2019.07.020. Epub 2019 Jul 23.
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.
The purpose of this study was to determine the outcomes of catheter ablation after TV surgery in a large ACHD cohort.
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.
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).
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.
三尖瓣（TV）手术通常是成人先天性心脏病（ACHD）所必需的，但当人工材料或重叠组织覆盖三尖瓣环时，可能会阻碍导管消融。
本研究旨在确定在大型 ACHD 队列中 TV 手术后导管消融的结果。
进行了一项涉及 7 个中心的国际回顾性研究。对接受和未接受 TV 手术的患者进行年龄、病变分类和手术后时间的匹配。TV 手术分为瓣环/置换与修复。
136 例患者（42 例瓣环/置换，39 例修复，55 例无 TV 手术；中位数 32 岁[IQR 20-46]）共行 180 次消融治疗 239 次心动过速（腔静脉峡部依赖房内折返性心动过速 36%，其他房内折返性心动过速 29%，局灶性房性心动过速 18%，其他室上性心动过速 17%）。TV 手术后，手术时间更长（4.3 小时比 3.3 小时；P =.003），透视时间更长（31 分钟比 18 分钟；P =.001）。TV 瓣环/置换组至少部分急性成功的比例为 81%，而 TV 修复和无 TV 手术组分别为 94%（P =.03）。这种差异主要是由环部基质消融引起的，TV 瓣环/置换组急性成功的比例为 73%，TV 修复组为 92%，无 TV 手术组为 94%（P =.01）。在中位 3.0 年的随访中，26%的手术后心动过速复发。多变量分析显示 TV 瓣环/置换是复发的预测因素（风险比 2.4；95%置信区间 1.2-5.2；P =.009）。
在 ACHD 手术后，TV 瓣环/置换手术的导管消融成功率较低，心动过速复发率较高。本回顾性报告的结果支持未来更大的多中心系列和前瞻性评估，以确定经验性环形基质消融的作用。
