Mechanism and outcomes of catheter ablation for ventricular tachycardia in adults with repaired congenital heart disease

Martin van Zyl, Suraj Kapa, Deepak Padmanabhan, Frank C. Chen, Siva Mulpuru, Douglas L Packer, Thomas M. Munger, Samuel J Asirvatham, Christopher J. McLeod

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Repaired congenital heart disease (rCHD) is strongly associated with ventricular tachycardia (VT) as an important late cause of morbidity and mortality. Ventricular reentry most commonly includes anatomic isthmuses created during the repair procedures. Objective: The purpose of this study was to analyze the long-term outcomes of catheter ablation, a commonly used standalone or adjunctive therapy, in a cohort of rCHD patients. Methods: A retrospective analysis of 21 consecutive patients with rCHD (45.0 ± 3.0 years, 71.4% male) undergoing ablation for VT was performed. The primary composite outcome was defined as in-hospital arrhythmic death, out-of-hospital sudden cardiac death, or appropriate implantable cardioverter-defibrillator therapy. Results: At initial electrophysiologic study, 14 patients (66.7%) had reentrant VT through an electroanatomic isthmus; the remaining 7 patients (33.3%) demonstrated focal VT. Isthmus-dependent reentry was identified as the mechanism for VT in 14 patients (66.7%), and conduction block was confirmed in 8 of these patients (57.1%). No patients with confirmed block developed VT recurrence. During long-term follow-up (33 ± 7 months), 20 of 21 patients (95.2%) had not reached the primary composite outcome. Three patients died of nonarrhythmic causes. Conclusion: Catheter-based VT ablation in patients with rCHD is associated with a low rate of VT recurrence. Focal VT was not uncommon in this cohort. If a reentrant mechanism is present, confirmation of conduction block across the isthmus is vital to prevent recurrence.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2016

Fingerprint

Catheter Ablation
Ventricular Tachycardia
Heart Diseases
Recurrence
Implantable Defibrillators
Sudden Cardiac Death
Catheters
Morbidity

Keywords

  • Adult congenital heart disease
  • Cardiac electrophysiology
  • Catheter ablation
  • Ventricular arrhythmia
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Mechanism and outcomes of catheter ablation for ventricular tachycardia in adults with repaired congenital heart disease. / van Zyl, Martin; Kapa, Suraj; Padmanabhan, Deepak; Chen, Frank C.; Mulpuru, Siva; Packer, Douglas L; Munger, Thomas M.; Asirvatham, Samuel J; McLeod, Christopher J.

In: Heart Rhythm, 2016.

Research output: Contribution to journalArticle

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abstract = "Background: Repaired congenital heart disease (rCHD) is strongly associated with ventricular tachycardia (VT) as an important late cause of morbidity and mortality. Ventricular reentry most commonly includes anatomic isthmuses created during the repair procedures. Objective: The purpose of this study was to analyze the long-term outcomes of catheter ablation, a commonly used standalone or adjunctive therapy, in a cohort of rCHD patients. Methods: A retrospective analysis of 21 consecutive patients with rCHD (45.0 ± 3.0 years, 71.4{\%} male) undergoing ablation for VT was performed. The primary composite outcome was defined as in-hospital arrhythmic death, out-of-hospital sudden cardiac death, or appropriate implantable cardioverter-defibrillator therapy. Results: At initial electrophysiologic study, 14 patients (66.7{\%}) had reentrant VT through an electroanatomic isthmus; the remaining 7 patients (33.3{\%}) demonstrated focal VT. Isthmus-dependent reentry was identified as the mechanism for VT in 14 patients (66.7{\%}), and conduction block was confirmed in 8 of these patients (57.1{\%}). No patients with confirmed block developed VT recurrence. During long-term follow-up (33 ± 7 months), 20 of 21 patients (95.2{\%}) had not reached the primary composite outcome. Three patients died of nonarrhythmic causes. Conclusion: Catheter-based VT ablation in patients with rCHD is associated with a low rate of VT recurrence. Focal VT was not uncommon in this cohort. If a reentrant mechanism is present, confirmation of conduction block across the isthmus is vital to prevent recurrence.",
keywords = "Adult congenital heart disease, Cardiac electrophysiology, Catheter ablation, Ventricular arrhythmia, Ventricular tachycardia",
author = "{van Zyl}, Martin and Suraj Kapa and Deepak Padmanabhan and Chen, {Frank C.} and Siva Mulpuru and Packer, {Douglas L} and Munger, {Thomas M.} and Asirvatham, {Samuel J} and McLeod, {Christopher J.}",
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T1 - Mechanism and outcomes of catheter ablation for ventricular tachycardia in adults with repaired congenital heart disease

AU - van Zyl, Martin

AU - Kapa, Suraj

AU - Padmanabhan, Deepak

AU - Chen, Frank C.

AU - Mulpuru, Siva

AU - Packer, Douglas L

AU - Munger, Thomas M.

AU - Asirvatham, Samuel J

AU - McLeod, Christopher J.

PY - 2016

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N2 - Background: Repaired congenital heart disease (rCHD) is strongly associated with ventricular tachycardia (VT) as an important late cause of morbidity and mortality. Ventricular reentry most commonly includes anatomic isthmuses created during the repair procedures. Objective: The purpose of this study was to analyze the long-term outcomes of catheter ablation, a commonly used standalone or adjunctive therapy, in a cohort of rCHD patients. Methods: A retrospective analysis of 21 consecutive patients with rCHD (45.0 ± 3.0 years, 71.4% male) undergoing ablation for VT was performed. The primary composite outcome was defined as in-hospital arrhythmic death, out-of-hospital sudden cardiac death, or appropriate implantable cardioverter-defibrillator therapy. Results: At initial electrophysiologic study, 14 patients (66.7%) had reentrant VT through an electroanatomic isthmus; the remaining 7 patients (33.3%) demonstrated focal VT. Isthmus-dependent reentry was identified as the mechanism for VT in 14 patients (66.7%), and conduction block was confirmed in 8 of these patients (57.1%). No patients with confirmed block developed VT recurrence. During long-term follow-up (33 ± 7 months), 20 of 21 patients (95.2%) had not reached the primary composite outcome. Three patients died of nonarrhythmic causes. Conclusion: Catheter-based VT ablation in patients with rCHD is associated with a low rate of VT recurrence. Focal VT was not uncommon in this cohort. If a reentrant mechanism is present, confirmation of conduction block across the isthmus is vital to prevent recurrence.

AB - Background: Repaired congenital heart disease (rCHD) is strongly associated with ventricular tachycardia (VT) as an important late cause of morbidity and mortality. Ventricular reentry most commonly includes anatomic isthmuses created during the repair procedures. Objective: The purpose of this study was to analyze the long-term outcomes of catheter ablation, a commonly used standalone or adjunctive therapy, in a cohort of rCHD patients. Methods: A retrospective analysis of 21 consecutive patients with rCHD (45.0 ± 3.0 years, 71.4% male) undergoing ablation for VT was performed. The primary composite outcome was defined as in-hospital arrhythmic death, out-of-hospital sudden cardiac death, or appropriate implantable cardioverter-defibrillator therapy. Results: At initial electrophysiologic study, 14 patients (66.7%) had reentrant VT through an electroanatomic isthmus; the remaining 7 patients (33.3%) demonstrated focal VT. Isthmus-dependent reentry was identified as the mechanism for VT in 14 patients (66.7%), and conduction block was confirmed in 8 of these patients (57.1%). No patients with confirmed block developed VT recurrence. During long-term follow-up (33 ± 7 months), 20 of 21 patients (95.2%) had not reached the primary composite outcome. Three patients died of nonarrhythmic causes. Conclusion: Catheter-based VT ablation in patients with rCHD is associated with a low rate of VT recurrence. Focal VT was not uncommon in this cohort. If a reentrant mechanism is present, confirmation of conduction block across the isthmus is vital to prevent recurrence.

KW - Adult congenital heart disease

KW - Cardiac electrophysiology

KW - Catheter ablation

KW - Ventricular arrhythmia

KW - Ventricular tachycardia

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