Key result
Empirical CTI ablation linked to ~53% lower atrial arrhythmia recurrence risk in congenital heart disease.
Why the study?
Recurrence rates of atrial arrhythmias after catheter ablation in congenital heart disease patients remain substantial, and the impact of empirical cavotricuspid isthmus ablation is unclear.
Does empirical CTI ablation prevent atrial arrhythmia recurrence in patients with congenital heart disease undergoing first catheter ablation?
Cohort (n=230)
Yes
Does empirical CTI ablation prevent atrial arrhythmia recurrence in patients with congenital heart disease undergoing first catheter ablation?
Empirical CTI ablation during first atrial arrhythmia ablation in CHD patients significantly reduces the risk of arrhythmia recurrence and related hospitalizations, particularly in those without a history of atrial fibrillation.
May lower recurrence after ablation in congenital heart disease; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Recurrence rates of atrial arrhythmias after catheter ablation in patients with congenital heart disease (CHD) remain substantial. Given the high prevalence of peritricuspid flutter, systematic cavotricuspid isthmus (CTI) ablation may represent a rational preventive strategy. OBJECTIVES: The objective of this study was to assess the impact of empirical CTI ablation in CHD patients. METHODS: This prospective nationwide study included all CHD patients referred for a first catheter ablation of an atrial arrhythmia between 2020 and 2024. Empirical ablation comprised probabilistic (noninducible arrhythmia with prior documentation) and prophylactic (no prior documentation) ablation. The primary endpoint was freedom from any atrial arrhythmia recurrence. Secondary endpoints included arrhythmia-related hospitalizations, redo ablations, and complications. RESULTS: Among 575 patients undergoing a first catheter ablation for atrial arrhythmia, 345 (60.0%) had CTI-dependent flutter. The remaining 230 patients formed the study population (mean age: 48.2 ± 16.4 years; 50.9% male). CHD complexity was predominantly moderate (57.4%). Targeted arrhythmias were atrial macro-re-entry (53.0%), atrial fibrillation (47.0%), and focal atrial tachycardia (17.4%), with multiple arrhythmias in 16.5%. Empirical CTI ablation was performed in 71 patients (30.9%) and was associated with significantly higher freedom from any atrial arrhythmia at 1 year (78.1% vs 65.6%, P = 0.010) and 2 years (71.2% vs 56.1%, P = 0.025), remaining independently associated with lower risk of recurrence after multivariable adjustment (HR: 0.47, 95% CI: 0.24-0.92, P = 0.027). This benefit was primarily observed in patients without atrial fibrillation history (interaction P = 0.005). Arrhythmia-related hospitalization was also significantly reduced (14.1% vs 25.8%, P = 0.048). CONCLUSIONS: Empirical CTI ablation is associated with improved freedom from atrial arrhythmia and reduced rehospitalization in CHD patients.
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Ditac et al. (2026) conducted a cohort in Congenital heart disease with atrial arrhythmia (n=230). Empirical cavotricuspid isthmus (CTI) ablation vs. No empirical CTI ablation was evaluated on Freedom from any atrial arrhythmia recurrence (HR 0.47, 95% CI 0.24-0.92, p=0.027). Empirical cavotricuspid isthmus ablation in patients with congenital heart disease was associated with a lower risk of atrial arrhythmia recurrence (HR 0.47; 95% CI 0.24-0.92; P=0.027).
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