Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences.

BACKGROUND: Catheter ablation has evolved as a possible curative treatment modality for atrial tachyarrhythmia (AT) in patients with congenital heart defects (CHD). However, data on long-term outcome are scarce. We examined characteristics of recurrent AT after ablation of postoperative AT during long-term follow-up in CHD patients. METHODS AND
RESULTS: CHD patients (n=53; 27 men; age, 38+/-15 years) referred for catheter ablation of AT were studied during a follow-up period of 5+/-3 years. After ablative therapy of the first AT (n=53, 27 atrial flutter, cycle length=288+/-81 ms; 22 intra-atrial reentrant tachycardia, cycle length=309+/-81 ms; 5 focal atrial tachycardia, cycle length=380+/-147 ms; success rate, 65%), AT recurred (59% within the first year) in 29 patients; 15 underwent repetitive ablative therapy. Mechanisms underlying recurrent AT were similar in 7 patients (intra-atrial reentrant tachycardia, 2; atrial flutter, 5). The location of arrhythmogenic substrates of recurrent AT (intra-atrial reentrant tachycardia, focal atrial tachycardia) was different for all but 1 patient. After 5+/-3 years, 5 patients died of heart failure, 3 were lost to follow-up, and the remaining patients had sinus rhythm (n=31), AT (n=5), or atrial flutter (n=14). Antiarrhythmic drugs were used by 18 (57%) sinus rhythm patients.
CONCLUSIONS: Successive postoperative AT in CHD patients developing over time may be caused by different mechanisms, including focal and reentrant mechanisms. Recurrent AT originated from different locations, suggesting that these new AT were not caused by arrhythmogenicity of previous ablative lesions. Long-term outcome is often complicated by development of atrial fibrillation. Despite frequent need for repeat ablative therapy, most patients are in sinus rhythm.