Efficacy of catheter ablation for arrhythmia in adults with congenital heart disease: A meta-analysis of clinical outcomes.

BACKGROUND

Arrhythmias remain a major clinical challenge in adult congenital heart disease (aCHD), contributing significantly to increased hospitalization rates and cardiac complications, affecting over 50% of aCHD patients. Catheter ablation (CA) is regarded as a first-line therapeutic modality due to its potential for disease modification. However, concerns persist regarding its long-term efficacy and safety. Thus, a comprehensive evaluation of CA outcomes in this population is warranted.

METHODS

The outcomes of interest were the success rate, secondary ablation rate, complication rates, and recurrence of arrhythmias. Quality assessment was done using the Risk of Bias in Non-randomized Studies of Interventions tool, and meta-analysis was performed using RStudio.

RESULTS

A comprehensive search of seven databases yielded 15 articles for analysis, among which 10 were categorized as low-risk, four as moderate-risk, and one lacked information regarding bias. The single-arm meta-analysis, examining events per 100 observations, revealed a success rate of 85.37 (95% confidence interval [CI] =78.50, 92.24). Moreover, the secondary ablation rate was determined to be 29.29 (95% CI = 16.92, 41.66), while major complications occurred at a rate of 2.81 (95% CI = 0.89, 4.73) and minor complications at a rate of 5.29 (95% CI = 1.88, 8.70). The overall recurrence rate of arrhythmias was found to be 40.33 (95% CI = 28.37, 52.29), with specific rates for intra-atrial reentrant tachycardia at 20.33 (95% CI = 11.24, 29.43), atrial fibrillation at 14.25 (95% CI = 3.46, 25.05), and atrioventricular nodal reentrant tachycardia at 9.70 (95% CI = 0.00, 19.56). Lastly, the implantation rate of implantable cardioverter defibrilators (ICDs) was found to be 1.05 (95% CI = 0.12, 1.99).

CONCLUSION

CA for arrhythmias in aCHD patients demonstrates high success rates with minimal procedural complications. However, the substantial recurrence rates highlight the need for ongoing monitoring and proactive strategies to optimize long-term outcomes.