Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T09:22:42.971Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiofrequency ablation of atrial tachyarrhythmias in adults with tetralogy of Fallot – predictors of success and outcome

Published online by Cambridge University Press:  26 May 2016

Vivienne A. Ezzat Open the ORCID record for Vivienne A. Ezzat [Opens in a new window] ,
Matthew J. Ryan ,
Justin O’Leary ,
Cono Ariti ,
John Deanfield ,
Bejal Pandya ,
Shay Cullen ,
Fiona Walker ,
Fakhar Khan  and
Dominic J. Abrams
...Show all authors
Vivienne A. Ezzat*
Affiliation:
The Heart Hospital, UCLH, London, UK
Matthew J. Ryan
Affiliation:
The Heart Hospital, UCLH, London, UK
Justin O’Leary
Affiliation:
The Heart Hospital, UCLH, London, UK
Cono Ariti
Affiliation:
London School of Hygiene and Tropical Medicine, London, United Kingdom
John Deanfield
Affiliation:
The Heart Hospital, UCLH, London, UK
Bejal Pandya
Affiliation:
The Heart Hospital, UCLH, London, UK
Shay Cullen
Affiliation:
The Heart Hospital, UCLH, London, UK
Fiona Walker
Affiliation:
The Heart Hospital, UCLH, London, UK
Fakhar Khan
Affiliation:
The Heart Hospital, UCLH, London, UK
Dominic J. Abrams
Affiliation:
Boston Children’s Hospital & Harvard Medical School, Boston, United States of America
Pier D. Lambiase
Affiliation:
The Heart Hospital, UCLH, London, UK
Martin D. Lowe
Affiliation:
The Heart Hospital, UCLH, London, UK
*
Correspondence to: V. A. Ezzat, MBChB PhD, Electrophysiology department, Barts Heart Centre, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK. Tel: +44 2037658755; Fax: +44 2034656179; E-mail: vivienne.ezzat@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Adults with tetralogy of Fallot experience atrial tachyarrhythmias; however, there are a few data on the outcomes of radiofrequency ablation. We examined the characteristics, outcome, and predictors of recurrence of atrial tachyarrhythmias after radiofrequency ablation in tetralogy of Fallot patients.

Methods/results

Retrospective data were collected from 2004 to 2013. In total, 56 ablations were performed on 37 patients. We identified two matched controls per case: patients with tetralogy of Fallot but no radiofrequency ablation and not known to have atrial tachyarrhythmias. Acute success was 98%. Left atrial arrhythmias increased in frequency over time. The mean follow-up was 41 months; 78% were arrhythmia-free. Number of cardiac surgeries, age, and presence of atrial fibrillation were predictors of recurrence. Lone cavo-tricuspid isthmus-dependent flutter reduced the likelihood of atrial fibrillation. Right and left atria in patients with tetralogy of Fallot were larger in ablated cases than controls. NYHA class was worse in cases and improved after ablation; baseline status predicted death. Of matched non-ablated controls, a number of them had atrial fibrillation. These patients were excluded from the case–control study but analysed separately. Most of them had died during follow-up, whereas of the matched ablated cases all were alive and the majority in sinus rhythm.

Conclusion

Patients with tetralogy of Fallot and atrial tachyarrhythmias have more dilated atria than those without atrial tachyarrhythmias. Radiofrequency ablation improves functional status. Left atrial ablation is more commonly required with repeat procedures. There is a high prevalence of atrial tachyarrhythmias, particularly atrial fibrillation, in patients with tetralogy of Fallot; early radiofrequency ablation may have a protective effect against this.

Keywords

Tetralogy of Fallotatrial tachycardiacatheter ablation
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 284 - 293
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Child, JS. Fallot’s tetralogy and pregnancy: prognostication and prophesy. J Am Coll Cardiol 2004; 44: 181–183.CrossRefGoogle ScholarPubMed
2. Gatzoulis, MA, Balaji, S, Webber, SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975–981.CrossRefGoogle ScholarPubMed
3. Koyak, Z, Harris, L, de Groot, JR, et al. Sudden cardiac death in adult congenital heart disease. Circulation 2012; 126: 1944–1954.CrossRefGoogle ScholarPubMed
4. Yap, SC, Harris, L, Chauhan, VS, Oechslin, EN, Silversides, CK. Identifying high risk in adults with congenital heart disease and atrial arrhythmias. Am J Cardiol 2011; 108: 723–728.CrossRefGoogle ScholarPubMed
5. Khairy, P, Aboulhosn, J, Gurvitz, MZ, et al. Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation 2010; 122: 868–875.CrossRefGoogle ScholarPubMed
6. Roos-Hesselink, J, Perlroth, MG, McGhie, J, Spitaels, S. Atrial arrhythmias in adults after repair of tetralogy of Fallot. Correlations with clinical, exercise, and echocardiographic findings. Circulation 1995; 91: 2214–2219.CrossRefGoogle ScholarPubMed
7. Verheugt, CL, Uiterwaal, CS, van der Velde, ET, et al. The emerging burden of hospital admissions of adults with congenital heart disease. Heart. 2010; 96: 872–878.CrossRefGoogle ScholarPubMed
8. Walsh, EP, Cecchin, F. Arrhythmias in adult patients with congenital heart disease. Circulation 2007; 115: 534–545.CrossRefGoogle ScholarPubMed
9. Wharton, G, Steeds, R, Allen, J, et al. Protocol written by the education committee of the British Society of Echocardiography 2012. Retrieved January 5, 2015, from www.bsecho.org/tte-minimum-dataset/.Google Scholar
10. Bonello, B, Kempny, A, Uebing, A, et al. Right atrial area and right ventricular outflow tract akinetic length predict sustained tachyarrhythmia in repaired tetralogy of Fallot. Int J Cardiol 2013; 168: 3280–3286.CrossRefGoogle ScholarPubMed
11. Rosianu, S, Paprika, D, Osztheimer, I, Temesvari, A, Szili-Torok, T. Echocardiographic evaluation of patients with undocumented arrhythmias occurring in adults late after repair of tetralogy of Fallot. Eur J Echocardiogr 2009; 10: 139–143.CrossRefGoogle ScholarPubMed
12. de Groot, NM, Lukac, P, Schalij, MJ, et al. Long-term outcome of ablative therapy of post-operative atrial tachyarrhythmias in patients with tetralogy of Fallot: a European multi-centre study. Europace 2012; 14: 522–527.CrossRefGoogle ScholarPubMed
13. Raine, D, O’Sullivan, J, Chaudhari, M, Hamilton, L, Hasan, A, Bourke, JP. Ablation of atrial tachyarrhythmias late after surgical repair of tetralogy of Fallot. Cardiol Young. 2011; 21: 31–38.CrossRefGoogle ScholarPubMed
14. Biviano, A, Garan, H, Hickey, K, Whang, W, Dizon, J, Rosenbaum, M. Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series. J Interv Card Electrophysiol 2010; 28: 125–135.CrossRefGoogle ScholarPubMed
15. Moe, GK. On multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther. 1962; 140: 183–188.Google Scholar
16. McCready, JW, Smedley, T, Lambiase, PD, et al. Predictors of recurrence following radiofrequency ablation for persistent atrial fibrillation. Europace 2011; 13: 355–361.CrossRefGoogle ScholarPubMed
17. Yap, SC, Harris, L, Silversides, CK, Downar, E, Chauhan, VS. Outcome of intra-atrial re-entrant tachycardia catheter ablation in adults with congenital heart disease: negative impact of age and complex atrial surgery. J Am Coll Cardiol. 2010; 56: 1589–1596.CrossRefGoogle ScholarPubMed