title: Ablation of supraventricular arrhythmias in adult congenital heart disease: A contemporary review.
abstract: Supraventricular arrhythmias are an important and increasing cause of morbidity in adults with congenital heart disease, requiring specific management strategies. Pharmacological treatment has limited efficacy, and is often associated with some side-effects. Major improvements in catheter ablation techniques have opened new opportunities to better understand underlying mechanisms of supraventricular arrhythmias, offer better therapy, and eventually improve symptoms and quality of life in these patients. An array of tools and techniques are necessary to access relevant anatomical areas to address the arrhythmogenic substrate. The mechanism of these arrhythmias is mostly related to macroreentry around surgical scars or cavotricuspid isthmus-dependent flutter. The efficacy of catheter ablation is mainly dependent on the underlying congenital heart condition, with the most complex cases typically being associated with atrial switch and Fontan surgeries. Although relatively high rates of recurrence are seen after a single procedure, additional attempts are often helpful to decrease recurrences and improve symptoms. Catheter ablation in such patients continues to present many unique challenges that are best addressed by experienced multidisciplinary teams, at centres equipped with the proper catheters, imaging capabilities, mapping systems and support staff needed to maximize safety and success. Consensus indications have emerged that often support ablation as first-line therapy in these patients. In this comprehensive review, we aim to describe the specific issues associated with ablation of supraventricular arrhythmias in adult congenital heart disease, assess the results in contemporary practice and, finally, review the current indications.
authors.affiliation: Paediatric and Adult Congenital Heart Disease Department, Arrhythmias Unit, Clinique Pasteur, 45, avenue de Lombez, 31070 Toulouse, France. Electronic address: n.combes@clinique-pasteur.com.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combes
authors.affiliation: Paediatric and Adult Congenital Heart Disease Department, Haut-Lévèque Hospital, Pessac, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Congenital Heart Disease Department, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Hascoët
authors.affiliation: Département de Cardiologie, Centre de Recherche Cardiovasculaire de Paris (INSERM U970), Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Zhao
authors.affiliation: Département de Cardiologie, Centre de Recherche Cardiovasculaire de Paris (INSERM U970), Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Amet
authors.affiliation: Paediatric and Adult Congenital Heart Disease Department, Arrhythmias Unit, Clinique Pasteur, 45, avenue de Lombez, 31070 Toulouse, France; Paediatric and Adult Congenital Heart Disease Department, Haut-Lévèque Hospital, Pessac, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Le Bloa
authors.affiliation: Department of Paediatric Cardiology, Necker Hospital, Paris, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Maltret
authors.affiliation: Paediatric and Adult Congenital Heart Disease Department, Arrhythmias Unit, Clinique Pasteur, 45, avenue de Lombez, 31070 Toulouse, France.
authors.forename: François
authors.initials: F
authors.lastname: Heitz
authors.affiliation: Paediatric and Adult Congenital Heart Disease Department, Haut-Lévèque Hospital, Pessac, France.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Thambo
authors.affiliation: Département de Cardiologie, Centre de Recherche Cardiovasculaire de Paris (INSERM U970), Hôpital Européen Georges-Pompidou, Paris, France; Université Paris Descartes, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D012307:Risk Factors; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ablation par cathéter; Cardiopathie congénitale; Catheter ablation; Congenital heart defect; Supraventriculaire; Supraventricular; Tachycardia; Tachycardie