Catheter Ablation of Ventricular Arrhythmias in Patients with Congenital Heart Diseases: A Nationwide Prospective Study

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2025-09-01 DOI:10.1016/j.acvd.2025.06.007

Francis Bessière , Jean-Luc Pasquié , Guillaume Duthoit , Raphaël Martins , Laure Champ-Rigot , Frédéric Sacher , Stefano Bartoletti , Charlene Bredy , Sok-Sithikun Bun , Antoine Da Costa , Christian De Chillou , Pascal Defaye , Nicolas Derval , Marie Wilkin , Eloi Marijon , Nicolas Combes , Victor Waldmann

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引用次数: 0

Abstract

Introduction

Sudden death and ventricular arrhythmias (VA) remain a significant concern among patients with congenital heart disease (CHD). While catheter ablation techniques have improved dramatically over the last decade, current evidence in this specific population is derived from small, retrospective studies. We aimed to describe the burden and characteristics of VAs targeted by catheter ablation in CHDs, as well as associated outcomes and emerging preventive ablative strategies.

Method

This prospective nationwide study included all CHD patients referred for catheter ablation of a VA from 2020 to 2024 in France. The primary outcome was the rate of per-procedural acute success. Secondary outcomes included complications as well as freedom from arrhythmia recurrence.

Results

Among a total of 1,192 consecutive catheter ablation procedures, 210 (17.6%) VA catheter ablations were performed in 190 patients (mean age 43.8 ± 15.5 years, 63.8% males): ventricular tachycardia (VT) was targeted in 164 (78.1%) procedures and premature ventricular complex (PVC) in 53 (25.2%) (both VT and PVC targeted in 7). Fourteen (6.7%) patients had a simple CHD, 161 (76.7%) a moderate CHD, and 35 (16.7%) a complex CHD. In patients with tetralogy of Fallot (n = 126), catheter ablation was performed without clinically documented VA in 46 (36.5%), mainly before transcatheter or surgical intervention. Overall, the clinical arrhythmia was successfully ablated in 182 (86.7%) patients. An acute complication was reported in 6 (2.9%) procedures, with no related death. The overall 1-year and 2-year rates of freedom from recurrence were 81.5% (95% CI 75.3 − 88.4%) and 78.2% (95% CI 71.2 − 85.8%). The presence of anatomical isthmuses related to prior cardiac surgeries was associated with lower recurrence rates (HR 0.30, 95% CI 0.14 − 0.64, p < 0.001).

Conclusion

Ventricular arrhythmias represent approximately 20% of catheter ablation procedures performed in CHD patients. This large cohort provides key insights into the effectiveness of catheter ablation and the main mechanisms of VAs in patients with CHD. The significant differences in outcomes demonstrated depending on underlying substrate are important to consider to inform the benefit/risk assessment.

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导管消融治疗先天性心脏病患者室性心律失常：一项全国性的前瞻性研究

猝死和室性心律失常（VA）仍然是先天性心脏病（CHD）患者关注的一个重要问题。虽然导管消融技术在过去十年中有了显著的进步，但目前在这一特定人群中的证据来自小型回顾性研究。我们的目的是描述导管消融在CHDs中针对VAs的负担和特征，以及相关的结果和新兴的预防性消融策略。方法：这项前瞻性全国研究纳入了法国2020年至2024年期间所有接受房颤导管消融治疗的冠心病患者。主要观察指标是手术急性成功率。次要结果包括并发症以及心律失常复发的自由。结果在总共1192例连续导管消融手术中，190例患者（平均年龄43.8±15.5岁，男性占63.8%）进行了210例（17.6%）室性心动过速（VT）手术，164例（78.1%）手术靶向室性早搏（PVC）， 53例（25.2%）手术靶向室性早搏（PVC和VT均有7例）。14例（6.7%）为单纯性冠心病，161例（76.7%）为中度冠心病，35例（16.7%）为复杂冠心病。在法洛四联症患者（n = 126）中，46例（36.5%）患者进行了导管消融，但无临床记录的VA，主要是在经导管或手术干预之前。总体而言，182例（86.7%）患者的临床心律失常得到成功消融。6例（2.9%）手术发生急性并发症，无相关死亡。总体1年和2年无复发率分别为81.5% （95% CI 75.3 ~ 88.4%）和78.2% （95% CI 71.2 ~ 85.8%）。与既往心脏手术相关的解剖性峡部的存在与较低的复发率相关（HR 0.30, 95% CI 0.14 - 0.64, p < 0.001）。结论室性心律失常约占冠心病患者导管消融手术的20%。这一大型队列研究为冠心病患者导管消融的有效性和VAs的主要机制提供了关键见解。结果的显著差异取决于潜在的基质，这是重要的考虑因素，以便为利益/风险评估提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.