Медицинская библиотека · JACC. Clinical electrophysiology · 2026

Empirical Cavotricuspid Isthmus Ablation in Congenital Heart Disease: A Nationwide Prospective Study.

Ditac Geoffroy, Bessière Francis, Duthoit Guillaume, Pasquié Jean-Luc, Champ-Rigot Laure, Albertini Mathieu, Anselme Frédéric, Bartoletti Stefano, Bonnet Damien, Bredy Charlène, Bun Sok-Sithikun, Clerici Gaël, Da Costa Antoine, De Chillou Christian, Defaye Pascal, de Guillebon Maxime, Davril Clément, Delinière Antoine, Derval Nicolas, Dib Nabil, Donisi Luca, Gardey Kevin, Ghanimé Caroline, Gourraud Jean-Baptiste, Hascoët Sébastien, Hammache Néfissa, Henaine Roland, Iserin Laurence, Jacon Peggy, Jourda François, Karsenty Clément, Khairy Paul, Koutbi Linda, Laurent Gabriel, Maille Baptiste, Maltret Alice, Mansourati Jacques, Marimpouy Nathan, Martins Raphaël, Maury Philippe, Milhem Antoine, Moceri Pamela, Ollitrault Pierre, Pinon Pauline, Piot Olivier, Benali Karim, Racelma Kahina, Richard-Vitton Robin, Sacher Frédéric, Sebag Frédéric, Tortigue Marine, Venier Sandrine, Wilkin Marie, Winum Pierre-François, Marijon Eloi, Combes Nicolas, Waldmann Victor, CATCH Investigators

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Аннотация

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.

Для цитирования: Ditac Geoffroy, Bessière Francis, Duthoit Guillaume, Pasquié Jean-Luc, Champ-Rigot Laure, Albertini Mathieu, Anselme Frédéric, Bartoletti Stefano, Bonnet Damien, Bredy Charlène, Bun Sok-Sithikun, Clerici Gaël, Da Costa Antoine, De Chillou Christian, Defaye Pascal, de Guillebon Maxime, Davril Clément, Delinière Antoine, Derval Nicolas, Dib Nabil, Donisi Luca, Gardey Kevin, Ghanimé Caroline, Gourraud Jean-Baptiste, Hascoët Sébastien, Hammache Néfissa, Henaine Roland, Iserin Laurence, Jacon Peggy, Jourda François, Karsenty Clément, Khairy Paul, Koutbi Linda, Laurent Gabriel, Maille Baptiste, Maltret Alice, Mansourati Jacques, Marimpouy Nathan, Martins Raphaël, Maury Philippe, Milhem Antoine, Moceri Pamela, Ollitrault Pierre, Pinon Pauline, Piot Olivier, Benali Karim, Racelma Kahina, Richard-Vitton Robin, Sacher Frédéric, Sebag Frédéric, Tortigue Marine, Venier Sandrine, Wilkin Marie, Winum Pierre-François, Marijon Eloi, Combes Nicolas, Waldmann Victor, CATCH Investigators. Empirical Cavotricuspid Isthmus Ablation in Congenital Heart Disease: A Nationwide Prospective Study.. JACC. Clinical electrophysiology. 2026. DOI: 10.1016/j.jacep.2026.07.023.

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