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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
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
Corresponding
E-mail address:

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.

Type
Original Articles
Copyright
© Cambridge University Press 2016 

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References

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