Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, EC1A 7BE, London, UK.
Grown-up Congenital Heart Disease Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
J Interv Card Electrophysiol. 2021 Jan;60(1):49-56. doi: 10.1007/s10840-019-00692-y. Epub 2020 Jan 29.
Catheter ablation for supraventricular tachycardia (SVT) in adults with congenital heart disease (ACHD) is an important therapeutic option. Cavo-tricuspid isthmus (CTI)-dependent intraatrial re-entrant tachycardia (IART) is common. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised that performing an empiric CTI line in case of non-inducibility leads to good outcomes. Long-term outcomes of empiric versus entrained CTI ablation in ACHD patients were examined.
Retrospective, single-centre, case-control study over 7 years. Arrhythmia-free survival after empiric versus entrained CTI ablation was compared.
Eighty-seven CTI ablations were performed in 85 ACHD patients between 2010 and 2017. The mean age of the cohort was 43 years and 48% were male. Underlying aetiology included ASD (31%), VSD (11.4%), AVSD (9.1%), AVR (4.8%), Fallot's (18.4%), Ebstein's (2.3%), Fontan's palliation (9.2%) and atrial switch (13.8%). CTI-dependent IART was entrained in 59 patients whereas it was non-inducible in 28. The latter had an empiric CTI ablation. Forty-three percent of procedures were performed under general anaesthesia. There were no reported procedural complications. There was no significant difference in the mean procedure or fluoroscopy times between the groups (empiric vs entrained CTI; 169.1 vs 183.3 and 28.1 vs 19.9 min). Arrhythmia-free survival was 64.3% versus 72.8% (p value 0.44) in the empiric and entrained groups at 21 months follow-up.
Long-term outcomes after empiric and entrained CTI ablation for IART in ACHD patients are comparable. This is a safe and effective therapeutic option. In the case of non-inducibility of IART, an empiric CTI line should be considered in this cohort.
导管消融术治疗成人先天性心脏病（ACHD）合并的室上性心动过速（SVT）是一种重要的治疗选择。三尖瓣峡部依赖型房内折返性心动过速（IART）较为常见。然而，消融时并非总能诱发持续性心动过速。我们假设在不能诱发出持续性心动过速的情况下进行经验性峡部消融，可获得良好的结果。本研究旨在探讨 ACHD 患者经验性峡部消融与顺行峡部消融的长期预后。
这是一项回顾性、单中心、7 年时间跨度的病例对照研究。比较经验性峡部消融与顺行峡部消融后心律失常无复发的生存情况。
2010 年至 2017 年间，共有 85 例 ACHD 患者共进行了 87 次 CTI 消融术。该队列的平均年龄为 43 岁，48%为男性。基础病因包括房间隔缺损（31%）、室间隔缺损（11.4%）、房室间隔缺损（9.1%）、主动脉瓣下狭窄（4.8%）、法洛四联症（18.4%）、Ebstein 畸形（2.3%）、Fontan 手术（9.2%）和心房调转术（13.8%）。59 例患者的 IART 可被顺行诱出，28 例患者的 IART 不可被诱出。后者进行了经验性峡部消融。43%的手术在全身麻醉下进行。两组患者的平均手术时间或透视时间无显著差异（经验性 CTI 消融与顺行 CTI 消融组分别为 169.1 分钟 vs 183.3 分钟和 28.1 分钟 vs 19.9 分钟）。在 21 个月的随访中，经验性组和顺行组的无心律失常生存率分别为 64.3%和 72.8%（p 值为 0.44）。
在 ACHD 患者中，对于 IART 进行经验性峡部消融和顺行峡部消融的长期预后相当。这是一种安全有效的治疗选择。对于 IART 不能被诱发出的患者，在该患者群体中应考虑进行经验性峡部消融。
