Published online before print June 3, 2009, doi: 10.1161/CIRCEP.108.828137
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Original Articles |
Long-Term Outcome of Ablative Therapy of Postoperative Supraventricular Tachycardias in Patients With Univentricular Heart
A European Multicenter Study
From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
Correspondence to Martin J. Schalij, MD, PhD, Department of Cardiology, C5-P, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail m.j.schalij{at}lumc.nl
Received October 20, 2008; accepted March 23, 2009.
Background— Catheter ablation has evolved as a possible curative treatment modality for supraventricular tachycardias (SVT) in patients with univentricular heart. However, the long-term outcome of ablation procedures is unknown. We evaluated the procedural and long-term outcome of ablative therapy of late postoperative SVT in patients with univentricular heart.
Methods and Results— Patients with univentricular heart (n=19, 11 male; age, 29±9 years) referred for ablation of SVT were studied. Ablation was guided by 3D electroanatomic mapping in all but 2 procedures. A total of 41 SVT were diagnosed as intra-atrial reentrant tachycardia (n=30; cycle length, 310±68 ms), typical atrial flutter (n=4; cycle length, 288±42 ms), focal atrial tachycardia (n=6; cycle length, 400±60 ms), and atrial fibrillation (n=1). Ablation was successful in 73% of intra-atrial reentrant tachycardia, 75% of atrial flutter, and all focal atrial tachycardia and focal atrial fibrillation. During the follow-up period of 53±34 months, 2 patients were lost to follow-up, 3 died of heart failure, 2 underwent heart transplantation, and 1 underwent conduit replacement. Of the remaining group, 8 had sinus rhythm and 3 had SVT.
Conclusions— Focal and reentrant mechanisms underlie postoperative SVT in patients with univentricular heart. Successive SVT developing over time may be caused by different mechanisms. Ablative therapy is potentially curative, with a procedural success rate of 78%. In patients who had multiple ablation procedures, the SVT originated from different atrial sites, suggesting that these new SVT were caused by progressive atrial disease. Despite recurrent SVT, sinus rhythm at the end of the follow-up period was achieved in 72%.
Key Words: heart defects • congenital • tachyarrhythmias • mapping • ablation