Long-Term Outcome of Ablative Therapy of Postoperative Supraventricular Tachycardias in Patients With Univentricular Heart: A European Multicenter Study
Circulation: Arrhythmia and Electrophysiology
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 (nϭ19, 11 male; age, 29Ϯ9 years) referred for ablation of SVT were studied.
... 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 (nϭ30; cycle length, 310Ϯ68 ms), typical atrial flutter (nϭ4; cycle length, 288Ϯ42 ms), focal atrial tachycardia (nϭ6; cycle length, 400Ϯ60 ms), and atrial fibrillation (nϭ1). 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 53Ϯ34 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%. (Circ Arrhythmia Electrophysiol. 2009;2:242-248.)