title: Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease.
abstract: Atrial myopathy, atriotomies, and fibrotic scars are the pathophysiological substrate of lines of conduction block, promoting atrial macroreentry. The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for right atrial tachyarrhythmia (AT) in adults after cardiac surgery for congenital heart disease (CHD) and acquired heart disease (AHD) and predictors of these outcomes. Clinical records of adults after surgery for heart disease undergoing RFCA of right-sided AT were analyzed retrospectively. Multivariate analyses identified clinical and procedural factors predicting acute and long-term outcomes. A total of 372 patients (69% men; age 61 ± 15 years) after surgical repair of CHD (n = 111) or AHD (n = 261) were studied. Cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) was observed in 300 patients and non-CTI-AFL in 72 patients. Ablation was successful in 349 cases (94%). During a mean follow-up of 51 ± 30 months, recurrences were observed in 24.5% of patients. Multivariate analysis showed that non-CTI-AFL (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.1 to 2.9) and CHD (HR 1.75, 95% CI 1.07 to 2.9) were independent predictors of long-term recurrences. Multivariate analysis showed that female gender (HR 2.29, 95% CI 1.6 to 3.3), surgery for AHD (HR 95% 2.31, 95% CI 1.5 to 3.7), and left atrial dilatation (HR 2.1, 95% CI 1.3 to 3.2) were independent predictors of long-term atrial fibrillation. In conclusion, RFCA of right-sided AT after cardiac surgery is associated with high acute success rates and significant long-term recurrences. Non-CTI-dependent AFL and surgery for CHD are at higher risk of recurrence. Atrial fibrillation is common during follow-up, particularly in patients with AHD and enlarged left atrium.
authors.affiliation: Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Spain. Electronic address: ianguera@bellvitgehospital.cat.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Anguera
authors.affiliation: Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Spain.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dallaglio
authors.affiliation: Hospital Universitario Virgen de las Nieves de Granada, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Macías
authors.affiliation: Instituto de Investigación Biomédica de Salamanca-IBSAL, Hospital Universitario de Salamanca, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Jiménez-Candil
authors.affiliation: Hospital Universitario La Paz de Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Peinado
authors.affiliation: Hospital Clínico Universitario de Santiago de Compostela, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Seara
authors.affiliation: Hospital de Basurto de Bilbao, Spain.
authors.forename: Mari Fe
authors.initials: MF
authors.lastname: Arcocha
authors.affiliation: Hospital Universitario Río Hortega de Valladolid, Spain.
authors.forename: Benito
authors.initials: B
authors.lastname: Herreros
authors.affiliation: Hospital Universitario de Valencia, Spain.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Quesada
authors.affiliation: Hospital Universitario "Ramón y Cajal" de Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernández-Madrid
authors.affiliation: Hospital Universitario Virgen de las Nieves de Granada, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Alvarez
authors.affiliation: Hospital Universitario La Paz de Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Filgueiras
authors.affiliation: Hospital Universitario "Ramón y Cajal" de Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Matía
authors.affiliation: Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.affiliation: Heart Disease Institute, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Sabaté
mesh_terms: D006348:Cardiac Surgical Procedures; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006331:Heart Diseases / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain; D013610:Tachycardia / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome