Published Online
on June 3, 2009

A more recent version of this article appeared on June 1, 2009

This Article Full Text (PDF) All Versions of this Article: 2/3/242    most recent CIRCEP.108.828137v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by de Groot, N. M.S. Articles by Schalij, M. J. PubMed PubMed Citation Articles by de Groot, N. M.S. Articles by Schalij, M. J. Related Collections Arrhythmias, clinical electrophysiology, drugs Ablation/ICD/surgery Electrophysiology

Original Article

Long-term Outcome of Ablative Therapy of Post-Operative Supraventricular Tachycardias In Patients with Univentricular Hearts: An European MultiCenter Study

Natasja M.S. de Groot¹; Peter Lukac²; Nico A. Blom¹; Jan Peter van Kuijk¹; Anders K. Pedersen³; Peter S. Hansen³; Etienne Delacrétaz⁴ and Martin J. Schalij^1,5

¹ Leiden University Medical Center, Leiden, the Netherlands;
² Aarhus University Hospital at Skejby, Aarhus, Denmark;
³ Varde Heart Center Varde, Denmark;
⁴ Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland

⁵ E-mail: m.j.schalij{at}lumc.nl

Background—Catheter ablation has evolved as a possible curative treatment modality for supraventricular tachycardias (SVT) in patients with univentricular hearts (UVH). However, the long-term outcome of ablation procedures is unknown. We evaluated the procedural and long-term outcome of ablative therapy of late, post-operative SVT in patients with UVH.

Methods and Results—Patients with UVH (N=19, 11 male, 29±9 yrs) referred for ablation of SVT were studied. Ablation was guided by 3-dimensional electroanatomical mapping in all but 2 procedures. A total of 41 SVT were diagnosed as intra atrial re-entrant tachycardia (IART, N=30, cycle length 310±68 ms), typical atrial flutter (AFL, N=4, cycle length 288±42 ms), focal atrial tachycardia (FAT, N=6, cycle length 400±60 ms) and atrial fibrillation (AF, N=1). Ablation was successful in 73% of the IART, 75% of the AFL and all FAT and focal AF. During the follow-up period of 53±34 months, 2 patients were lost to follow-up, 3 died due to heart failure, 2 underwent heart transplantation, 1 underwent conduit replacement. Of the remaining group, 8 had SR and 3 a SVT.

Conclusion—Focal and reentrant mechanisms underlie post-operative SVT in patients with UVH. 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: ablation • follow-up studies • heart defects, congenital • mapping