title: Re-entry using anatomically determined isthmuses: a curable ventricular tachycardia in repaired congenital heart disease.
abstract: BACKGROUND
  Ventricular tachycardia (VT) is an important cause of late morbidity and mortality in repaired congenital heart disease. The substrate often includes anatomic isthmuses that can be transected by radiofrequency catheter ablation similar to isthmus block for atrial flutter. This study evaluates the long-term efficacy of isthmus block for treatment of re-entry VT in adults with repaired congenital heart disease.
  
  
  RESULTS
  Thirty-four patients (49±13 years; 74% male) with repaired congenital heart disease who underwent radiofrequency catheter ablation of VT in 2 centers were included. Twenty-two (65%) had a preserved left and right ventricular function. Patients were inducible for 1 (interquartile range, 1-2) VT, median cycle length: 295 ms (interquartile range, 242-346). Ablation aimed to transect anatomic isthmuses containing VT re-entry circuit isthmuses. Procedural success was defined as noninducibility of any VT and transection of the anatomic isthmus and was achieved in 25 (74%) patients. During long-term follow-up (46±29 months), all patients with procedural success (18/25 with internal cardiac defibrillators) were free of VT recurrence but 7 of 18 experienced internal cardiac defibrillator-related complications. One patient with procedural success and depressed cardiac function received an internal cardiac defibrillator shock for ventricular fibrillation. None of the 18 patients (12/18 with internal cardiac defibrillators) with complete success and preserved cardiac function experienced any ventricular arrhythmia. In contrast, VT recurred in 4 of 9 patients without procedural success. Four patients died from nonarrhythmic causes.
  
  
  CONCLUSIONS
  In patients with repaired congenital heart disease with preserved ventricular function and isthmus-dependent re-entry, VT isthmus ablation can be curative.
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Gijsbert F L
authors.initials: GF
authors.lastname: Kapel
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Adrianus P
authors.initials: AP
authors.lastname: Wijnmaalen
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Sebastiaan R D
authors.initials: SR
authors.lastname: Piers
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.).
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.affiliation: From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands (G.F.L.K., A.P.W., S.R.D.P., E.R.H., M.J.S., K.Z.) and Department of Cardiology, Brigham and Women's Hospital, Boston, MA (T.R., U.B.T., W.G.S.). K.Zeppenfeld@lumc.nl.
authors.forename: Katja
authors.initials: K
authors.lastname: Zeppenfeld
mesh_terms: D000328:Adult; D001900:Boston; D006328:Cardiac Catheterization / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: catheter ablation; congenital heart disease; tachyarrhythmia