The Role of Atrial Arrhythmia Ablation in Adolescent and Adult Congenital Heart Disease

AbstractPurpose of ReviewAtrial arrhythmias cause significant morbidity in patients with congenital heart disease (CHD). Catheter ablation remains one of the most effective treatment modalities for atrial arrhythmias. However, patients with congenital heart disease present unique challenges for catheter ablation.Recent FindingsRecent expert consensus guidelines inform physicians about treating arrhythmias in patients with CHD. These guidelines outline appropriate selection criteria for ablation and highlight treatment alternatives. The authors also suggest electrophysiology laboratory and physician standards for performing these complex procedures. Recent studies report that 51% of atrial arrhythmias in CHD involve the cavo-tricuspid isthmus (CTI), 28% were non-CTI related and two types of IART were present in 21%. These studies link recurrence of tachycardia after ablation to CHD complexity, non-CTI-related arrhythmias, and patients with prolonged intra-atrial conduction. An analysis of patients with displaced AV nodes showed that cryoablation is a safe and effective technology to perform ablation in CHD with perinodal substrates. Changes in surgical Fontan palliation away from intracardiac baffles to extracardiac conduit has hopefully decreased arrhythmia burden in single ventricle patients. However, in those with atrial arrhythmias, access to the atria is complicated by no direct systemic venous access to the heart. Recent single-center and multicenter studies evaluated th...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research