Catheter ablation of supraventricular tachycardia after tricuspid valve surgery in patients with congenital heart disease: A multicenter comparative study

Jeremy P. Moore, Roberto G. Gallotti, Anca Chiriac, Christopher J. McLeod, Elizabeth A. Stephenson, Khadijah Maghrabi, Frank A. Fish, Orhan U. Kilinc, David Bradley, Ulrich Krause, Seshadri Balaji, Kevin M. Shannon

Research output: Contribution to journalArticle

Abstract

Background: Tricuspid valve (TV) surgery is often required for adult congenital heart disease (ACHD), but may hinder catheter ablation when an artificial material or imbricated tissue covers the tricuspid annulus. Objective: The purpose of this study was to determine the outcomes of catheter ablation after TV surgery in a large ACHD cohort. Methods: An international retrospective study involving 7 centers was conducted. Patients who did and did not undergo TV surgery were matched for age, lesion classification, and postsurgical duration. TV operations were classified as valve ring/replacement vs repair. Results: One hundred thirty-six patients (42 ring/replacement, 39 repair, and 55 no TV surgery; median 32 years [IQR 20 - 46]) underwent 180 procedures targeting 239 tachycardias (cavotricuspid-isthmus dependent intraatrial reentrant tachycardia 36%, other intraatrial reentrant tachycardia 29%, focal atrial tachycardia 18%, and other supraventricular tachyarrhythmia 17%). Post-TV surgery, procedures were longer (4.3 hours vs 3.3 hours; P = .003) and required longer fluoroscopy time (31 minutes vs 18 minutes; P = .001). At least partial acute success was achieved in 81% of procedures in the TV ring/replacement group vs 94% in both TV repair and no TV surgery groups (P = .03). The difference was driven mainly by ablation of annular substrates, with acute success in 73% of TV ring/replacement, 92% of TV repair, and 94% of no TV surgery groups (P = .01). Over a median of 3.0 years, tachycardia recurred after 26% of procedures. TV ring/replacement predicted recurrence in the multivariable analysis (hazard ratio 2.4; 95% confidence interval 1.2–5.2; P = .009). Conclusion: After surgery for ACHD, catheter ablation success was lower and tachycardia recurrence was higher after TV valve ring/replacement surgery. The findings of this retrospective report support future larger multicenter series and prospective evaluation to determine the role of empirical annular substrate ablation.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - Jan 1 2019

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Supraventricular Tachycardia
Tricuspid Valve
Catheter Ablation
Multicenter Studies
Heart Diseases
Tachycardia
Cardiac Catheters
Recurrence
Fluoroscopy

Keywords

  • Catheter ablation
  • Congenital heart disease
  • Ebstein's anomaly
  • Ring annuloplasty
  • Tricuspid valve repair
  • Tricuspid valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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Catheter ablation of supraventricular tachycardia after tricuspid valve surgery in patients with congenital heart disease : A multicenter comparative study. / Moore, Jeremy P.; Gallotti, Roberto G.; Chiriac, Anca; McLeod, Christopher J.; Stephenson, Elizabeth A.; Maghrabi, Khadijah; Fish, Frank A.; Kilinc, Orhan U.; Bradley, David; Krause, Ulrich; Balaji, Seshadri; Shannon, Kevin M.

In: Heart Rhythm, 01.01.2019.

Research output: Contribution to journalArticle

Moore, JP, Gallotti, RG, Chiriac, A, McLeod, CJ, Stephenson, EA, Maghrabi, K, Fish, FA, Kilinc, OU, Bradley, D, Krause, U, Balaji, S & Shannon, KM 2019, 'Catheter ablation of supraventricular tachycardia after tricuspid valve surgery in patients with congenital heart disease: A multicenter comparative study', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2019.07.020
Moore, Jeremy P. ; Gallotti, Roberto G. ; Chiriac, Anca ; McLeod, Christopher J. ; Stephenson, Elizabeth A. ; Maghrabi, Khadijah ; Fish, Frank A. ; Kilinc, Orhan U. ; Bradley, David ; Krause, Ulrich ; Balaji, Seshadri ; Shannon, Kevin M. / Catheter ablation of supraventricular tachycardia after tricuspid valve surgery in patients with congenital heart disease : A multicenter comparative study. In: Heart Rhythm. 2019.
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abstract = "Background: Tricuspid valve (TV) surgery is often required for adult congenital heart disease (ACHD), but may hinder catheter ablation when an artificial material or imbricated tissue covers the tricuspid annulus. Objective: The purpose of this study was to determine the outcomes of catheter ablation after TV surgery in a large ACHD cohort. Methods: An international retrospective study involving 7 centers was conducted. Patients who did and did not undergo TV surgery were matched for age, lesion classification, and postsurgical duration. TV operations were classified as valve ring/replacement vs repair. Results: One hundred thirty-six patients (42 ring/replacement, 39 repair, and 55 no TV surgery; median 32 years [IQR 20 - 46]) underwent 180 procedures targeting 239 tachycardias (cavotricuspid-isthmus dependent intraatrial reentrant tachycardia 36{\%}, other intraatrial reentrant tachycardia 29{\%}, focal atrial tachycardia 18{\%}, and other supraventricular tachyarrhythmia 17{\%}). Post-TV surgery, procedures were longer (4.3 hours vs 3.3 hours; P = .003) and required longer fluoroscopy time (31 minutes vs 18 minutes; P = .001). At least partial acute success was achieved in 81{\%} of procedures in the TV ring/replacement group vs 94{\%} in both TV repair and no TV surgery groups (P = .03). The difference was driven mainly by ablation of annular substrates, with acute success in 73{\%} of TV ring/replacement, 92{\%} of TV repair, and 94{\%} of no TV surgery groups (P = .01). Over a median of 3.0 years, tachycardia recurred after 26{\%} of procedures. TV ring/replacement predicted recurrence in the multivariable analysis (hazard ratio 2.4; 95{\%} confidence interval 1.2–5.2; P = .009). Conclusion: After surgery for ACHD, catheter ablation success was lower and tachycardia recurrence was higher after TV valve ring/replacement surgery. The findings of this retrospective report support future larger multicenter series and prospective evaluation to determine the role of empirical annular substrate ablation.",
keywords = "Catheter ablation, Congenital heart disease, Ebstein's anomaly, Ring annuloplasty, Tricuspid valve repair, Tricuspid valve replacement",
author = "Moore, {Jeremy P.} and Gallotti, {Roberto G.} and Anca Chiriac and McLeod, {Christopher J.} and Stephenson, {Elizabeth A.} and Khadijah Maghrabi and Fish, {Frank A.} and Kilinc, {Orhan U.} and David Bradley and Ulrich Krause and Seshadri Balaji and Shannon, {Kevin M.}",
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T2 - A multicenter comparative study

AU - Moore, Jeremy P.

AU - Gallotti, Roberto G.

AU - Chiriac, Anca

AU - McLeod, Christopher J.

AU - Stephenson, Elizabeth A.

AU - Maghrabi, Khadijah

AU - Fish, Frank A.

AU - Kilinc, Orhan U.

AU - Bradley, David

AU - Krause, Ulrich

AU - Balaji, Seshadri

AU - Shannon, Kevin M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Tricuspid valve (TV) surgery is often required for adult congenital heart disease (ACHD), but may hinder catheter ablation when an artificial material or imbricated tissue covers the tricuspid annulus. Objective: The purpose of this study was to determine the outcomes of catheter ablation after TV surgery in a large ACHD cohort. Methods: An international retrospective study involving 7 centers was conducted. Patients who did and did not undergo TV surgery were matched for age, lesion classification, and postsurgical duration. TV operations were classified as valve ring/replacement vs repair. Results: One hundred thirty-six patients (42 ring/replacement, 39 repair, and 55 no TV surgery; median 32 years [IQR 20 - 46]) underwent 180 procedures targeting 239 tachycardias (cavotricuspid-isthmus dependent intraatrial reentrant tachycardia 36%, other intraatrial reentrant tachycardia 29%, focal atrial tachycardia 18%, and other supraventricular tachyarrhythmia 17%). Post-TV surgery, procedures were longer (4.3 hours vs 3.3 hours; P = .003) and required longer fluoroscopy time (31 minutes vs 18 minutes; P = .001). At least partial acute success was achieved in 81% of procedures in the TV ring/replacement group vs 94% in both TV repair and no TV surgery groups (P = .03). The difference was driven mainly by ablation of annular substrates, with acute success in 73% of TV ring/replacement, 92% of TV repair, and 94% of no TV surgery groups (P = .01). Over a median of 3.0 years, tachycardia recurred after 26% of procedures. TV ring/replacement predicted recurrence in the multivariable analysis (hazard ratio 2.4; 95% confidence interval 1.2–5.2; P = .009). Conclusion: After surgery for ACHD, catheter ablation success was lower and tachycardia recurrence was higher after TV valve ring/replacement surgery. The findings of this retrospective report support future larger multicenter series and prospective evaluation to determine the role of empirical annular substrate ablation.

AB - Background: Tricuspid valve (TV) surgery is often required for adult congenital heart disease (ACHD), but may hinder catheter ablation when an artificial material or imbricated tissue covers the tricuspid annulus. Objective: The purpose of this study was to determine the outcomes of catheter ablation after TV surgery in a large ACHD cohort. Methods: An international retrospective study involving 7 centers was conducted. Patients who did and did not undergo TV surgery were matched for age, lesion classification, and postsurgical duration. TV operations were classified as valve ring/replacement vs repair. Results: One hundred thirty-six patients (42 ring/replacement, 39 repair, and 55 no TV surgery; median 32 years [IQR 20 - 46]) underwent 180 procedures targeting 239 tachycardias (cavotricuspid-isthmus dependent intraatrial reentrant tachycardia 36%, other intraatrial reentrant tachycardia 29%, focal atrial tachycardia 18%, and other supraventricular tachyarrhythmia 17%). Post-TV surgery, procedures were longer (4.3 hours vs 3.3 hours; P = .003) and required longer fluoroscopy time (31 minutes vs 18 minutes; P = .001). At least partial acute success was achieved in 81% of procedures in the TV ring/replacement group vs 94% in both TV repair and no TV surgery groups (P = .03). The difference was driven mainly by ablation of annular substrates, with acute success in 73% of TV ring/replacement, 92% of TV repair, and 94% of no TV surgery groups (P = .01). Over a median of 3.0 years, tachycardia recurred after 26% of procedures. TV ring/replacement predicted recurrence in the multivariable analysis (hazard ratio 2.4; 95% confidence interval 1.2–5.2; P = .009). Conclusion: After surgery for ACHD, catheter ablation success was lower and tachycardia recurrence was higher after TV valve ring/replacement surgery. The findings of this retrospective report support future larger multicenter series and prospective evaluation to determine the role of empirical annular substrate ablation.

KW - Catheter ablation

KW - Congenital heart disease

KW - Ebstein's anomaly

KW - Ring annuloplasty

KW - Tricuspid valve repair

KW - Tricuspid valve replacement

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