Catheter Ablation of Ventricular Arrhythmias in Patients With Congenital Heart Diseases: A Nationwide Prospective Study.
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Bessière Francis, Pasquié Jean-Luc, Duthoit Guillaume, Martins Raphael, Champ-Rigot Laure, Sacher Frédéric, Albertini Mathieu, Anselme Frédéric, Bartoletti Stefano, Bonnet Damien, Bredy Charlène, Bun Sok-Sithikun, Da Costa Antoine, De Chillou Christian, Defaye Pascal, de Guillebon Maxime, Davril Clément, Delinière Antoine, Derval Nicolas, Ditac Geoffroy, Dulac Arnaud, Gardey Kevin, Ghanimé Caroline, Hascoet Sébastien, Hammache Néfissa, Henaine Roland, Iserin Laurence, Jacon Peggy, Karsenty Clément, Koutbi Linda, Laurent Gabriel, Maille Baptiste, Maltret Alice, Marimpouy Nathan, Maury Philippe, Moceri Pamela, Ollitrault Pierre, Pinon Pauline, Racelma Kahina, Richard-Vitton Robin, Tajouri Asma, Tortigue Marine, Venier Sandrine, Wilkin Marie, Winum Pierre, Marijon Eloi, Combes Nicolas, Waldmann Victor, CATCH Investigators
Аннотация
OBJECTIVES: The aim of this study was to describe the burden and characteristics of VAs targeted by catheter ablation in CHDs, as well as associated outcomes and emerging preventive ablative strategies.
METHODS: This prospective nationwide study included all patients with CHD referred for catheter ablation of a VA from 2020 to 2024 in France. The primary outcome was the rate of per-procedural acute success. Secondary outcomes included complications as well as freedom from arrhythmia recurrence.
RESULTS: Among a total of 1,192 consecutive catheter ablation procedures, 210 (17.6%) VA catheter ablations were performed in 190 patients (mean age 43.8 ± 15.5 years; 63.8% male): ventricular tachycardia (VT) was targeted in 164 (78.1%) procedures and premature ventricular complex in 53 (25.2%) (both VT and premature ventricular complex were targeted in 7). Fourteen (6.7%) patients had a simple CHD, 161 (76.7%) a moderate CHD, and 35 (16.7%) a complex CHD. In patients with tetralogy of Fallot (n = 126), catheter ablation was performed without clinically documented VA in 46 (36.5%), mainly before transcatheter or surgical intervention. Overall, the clinical arrhythmia was successfully ablated in 182 (86.7%) patients. An acute complication was reported in 6 (2.9%) procedures, with no related death. The overall 1- and 2-year rates of freedom from recurrence were 81.5% (95% CI: 75.3%-88.4%) and 78.2% (95% CI: 71.2%-85.8%), respectively. The presence of anatomical isthmuses related to prior cardiac surgeries was associated with lower recurrence rates (HR: 0.30; 95% CI: 0.14-0.64; P < 0.001).
CONCLUSIONS: VAs represent approximately 20% of catheter ablation procedures performed in patients with CHD. This large cohort provides key insights into the effectiveness of catheter ablation and the main mechanisms of VAs in patients with CHD. The significant differences in outcomes reported depending on underlying substrate are important to consider to inform the benefit/risk assessment.