In-hospital outcomes of catheter ablation in atrial arrhythmias: a nationwide analysis of 2,901 patients with adult congenital heart disease compared to 787,995 without.

Background: Advances in pediatric cardiology and congenital heart surgery have increased the adult population with congenital heart disease (CHD), now facing long-term complications like atrial arrhythmias. Given the limited data and safety concerns in this unique and vulnerable patient group, this study analyzes in-hospital outcomes of atrial catheter ablation in CHD patients versus non-CHD patients from a German nationwide real-world registry.

Methods: Using health records, all atrial catheter ablation procedures in Germany from 2008 to 2021 were analyzed. After adjustment for confounders, safety performance endpoints were compared between patients with and without CHD.

Results: From 2008 to 2021, 790,896 patients underwent right or left atrial catheter ablation in Germany. Of these, 1004 patients were classified as simple CHD, 1,054 patients as moderate CHD and 843 patients as complex CHD. Age at time of procedure was lower with increasing complexity of the CHD. Atypical atrial flutter (5.5% vs. 21.8%; p < 0.001) and other atrial tachycardias (21.2% vs. 42.2%; p < 0.001) occurred more often in patients with complex CHD compared to patients without. Combined ablation in both atria was more often performed in complex CHD. Despite higher complexity, in-hospital mortality (< 0.2%) and other investigated complications were rare. After adjustment for baseline characteristics, type of arrhythmia and ablation location, the relative risk for serious adverse events (combination of mortality, stroke, intracerebral bleeding or pericardiocentesis) did not show a significant difference for patients with CHD.

Conclusion: Even in patients with CHD, complications are rare and after adjustment, no differences were identified concerning serious adverse events. Therefore, an ablation should not be generally avoided in patients with CHD due to concerns about complications although an individualized evaluation of the anatomy must be taken into account.