Does high-density 3D electro-anatomical mapping assist in the successful ablation of complex atrial arrhythmias in adult congenital heart disease patients?
High-resolution 3D electro-anatomic mapping is safe, feasible, and effective for the identification and ablation of complex atrial arrhythmias in patients with adult congenital heart disease.
INTRODUCTION: Adult Congenital Heart Disease (ACHD) patients suffer from multiple, and often atypical, atrial arrhythmias. 3D electro-anatomical mapping systems assist in the identification and ablation of arrhythmogenic substrates critical to the initiating of theses arrhythmias. METHODS: We report on patients with ACHD and atrial arrhythmias treated at our center using the high density Rhythmia (Boston Scientific. Marlborough, MA) mapping system. Procedural success was defined as no sustained arrhythmia inducible at the end of the procedure. Partial success was defined as non-inducibility of the clinical arrhythmia. RESULTS: Our cohort included 16 patients in whom 21 electro-anatomical mapping and ablations were performed. Most patients were female (13 patients, 87%) and the average age was 43.5 ± 10.3 years. The congenital heart disease diagnosis was varied, including Fontan circulation and atrial switch palliation for Transposition of the great arteries. The identified arrhythmias included 21 intra-atrial re-entrant tachycardias and nine focal atrial tachycardias. In 14 cases (66.6%) the procedure was successful, in five cases (23.8%) the procedure was partially successful, and two cases (9.5%) were unsuccessful. There were no procedure-related major adverse events reported. At mean follow up of 15.3 ± 12.6 months, there were four cases of recurrent arrhythmias (44% of patients), four re-do procedures, three patients (18.8%) were discontinued from their antiarrhythmic medications. CONCLUSION: Electro-anatomical mapping is useful in the identification and treatment of complex atrial arrhythmias in patients with ACHD. In this cohort, mapping-assisted ablation of complex atrial arrhythmias in patients with ACHD was safe, feasible, and demonstrated an acceptable success rate. CONDENSED ABSTRACT: Patients with ACHD have anomalous cardiac anatomy and atrial arrhythmias can often be atypical. Electro-anatomical mapping is useful in the identification and treatment of complex atrial arrhythmias among patients with ACHD. We found that the use of a high-resolution 3D electro-anatomic mapping is safe, feasible and effective for the treatment of complex atrial arrhythmias in ACHD.
Pravda et al. (2025) studied this question.