title: Radiofrequency ablation of atrial tachyarrhythmias in adults with tetralogy of Fallot - predictors of success and outcome.
abstract: BACKGROUND
  Adults with tetralogy of Fallot experience atrial tachyarrhythmias; however, there are a few data on the outcomes of radiofrequency ablation. We examined the characteristics, outcome, and predictors of recurrence of atrial tachyarrhythmias after radiofrequency ablation in tetralogy of Fallot patients. Methods/results Retrospective data were collected from 2004 to 2013. In total, 56 ablations were performed on 37 patients. We identified two matched controls per case: patients with tetralogy of Fallot but no radiofrequency ablation and not known to have atrial tachyarrhythmias. Acute success was 98%. Left atrial arrhythmias increased in frequency over time. The mean follow-up was 41 months; 78% were arrhythmia-free. Number of cardiac surgeries, age, and presence of atrial fibrillation were predictors of recurrence. Lone cavo-tricuspid isthmus-dependent flutter reduced the likelihood of atrial fibrillation. Right and left atria in patients with tetralogy of Fallot were larger in ablated cases than controls. NYHA class was worse in cases and improved after ablation; baseline status predicted death. Of matched non-ablated controls, a number of them had atrial fibrillation. These patients were excluded from the case-control study but analysed separately. Most of them had died during follow-up, whereas of the matched ablated cases all were alive and the majority in sinus rhythm.
  
  
  CONCLUSIONS
  Patients with tetralogy of Fallot and atrial tachyarrhythmias have more dilated atria than those without atrial tachyarrhythmias. Radiofrequency ablation improves functional status. Left atrial ablation is more commonly required with repeat procedures. There is a high prevalence of atrial tachyarrhythmias, particularly atrial fibrillation, in patients with tetralogy of Fallot; early radiofrequency ablation may have a protective effect against this.
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Vivienne A
authors.identifier: http://orcid.org/0000-0002-0076-3062
authors.initials: VA
authors.lastname: Ezzat
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ryan
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Justin
authors.initials: J
authors.lastname: O'Leary
authors.affiliation: 2London School of Hygiene and Tropical Medicine,London,United Kingdom.
authors.forename: Cono
authors.initials: C
authors.lastname: Ariti
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Bejal
authors.initials: B
authors.lastname: Pandya
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Shay
authors.initials: S
authors.lastname: Cullen
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Walker
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Fakhar
authors.initials: F
authors.lastname: Khan
authors.affiliation: 3Boston Children's Hospital & Harvard Medical School,Boston,United States of America.
authors.forename: Dominic J
authors.initials: DJ
authors.lastname: Abrams
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Pier D
authors.initials: PD
authors.lastname: Lambiase
authors.affiliation: 1The Heart Hospital,UCLH,London,UK.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Lowe
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Tetralogy of Fallot; atrial tachycardia; catheter ablation