Pulmonary vein isolation for the treatment of drug-refractory atrial fibrillation in adults with congenital heart disease.
Abstract
BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia in adults with congenital
heart disease (CHD). Long-term antiarrhythmic therapy (AAT) in these patients has
significant shortcomings. The safety and efficacy of pulmonary vein antrum isolation
(PVAI) for the treatment of AF in CHD is presently unknown. HYPOTHESIS: We hypothesized
that PVAI for AF in patients with CHD is effective and safe. METHODS: We reviewed
a prospective cohort of 4315 patients (age ≥ 18) undergoing PVAI for drug refractory
AF at a single institution and identified 36 consecutive patients with CHD (single
ventricle physiology, tetralogy of Fallot, coarctation of the aorta, ventricular septal
defects, atrial septal defects (ASD) and cardiomyopathy resulting from anomalous origin
of the left main coronary from the pulmonary artery). A second cohort of 355 consecutive
patients with noncongenital structural heart disease (NSHD) (coronary artery disease,
valvular heart disease, ejection fraction <50%, or prior noncongenital cardiac surgery)
undergoing PVAI during the same time period was used as a control. Success was defined
as freedom from AF starting two months after PVAI in the absence AAT until the end
of follow-up. Partial success was defined as freedom from AF in the presence of AAT
until the end of follow-up. Combined success was defined as the sum of success and
partial success. We compared the outcomes with the use of propensity-score matching
in the overall cohort. RESULTS: Patients with NSHD were older and had higher prevalence
of hypertension (P < .01), diabetes (P < .01) and hyperlipidemia (P < .01). The most
common CHD lesion was ASD (61%) and the most common NSHD lesion was valvular heart
disease (57%). After one PVAI, success was achieved in 42% and 53% at 300 days in
the CHD and NSHD groups respectively. Four-year success was achieved in 27% and 36%
in the CHD and NSHD groups, respectively. There were no significant differences in
the success rates between patients groups (P= .46), nor were there any differences
in left atrial size or changes in ejection fraction after one or two PVAI in the respective
groups. Complication rates between the CHD and NSHD groups were similar (15% vs. 11%,
P= .42) except for a higher risk of vascular site complications in patients with CHD
(8% vs. 1%, P < .05). CONCLUSION: PVAI is an attractive treatment modality in drug
refractory AF in CHD, with combined success rates in excess of 60%. The maintenance
of sinus rhythm after PVAI in CHD appears similar to that of NSHD and warrants prospective
validation.
Type
Journal articleSubject
Atrial FibrillationCardiac Surgical Procedures
Female
Heart Diseases
Humans
Male
Middle Aged
Pulmonary Veins
Retrospective Studies
Treatment Failure
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https://hdl.handle.net/10161/11013Published Version (Please cite this version)
10.1111/j.1747-0803.2012.00649.xPublication Info
Agarwal, S; Krasuski, Richard Andrew; Muhammad, KI; Natale, A; & Philip, F (2012). Pulmonary vein isolation for the treatment of drug-refractory atrial fibrillation
in adults with congenital heart disease. Congenit Heart Dis, 7(4). pp. 392-399. 10.1111/j.1747-0803.2012.00649.x. Retrieved from https://hdl.handle.net/10161/11013.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Richard Andrew Krasuski
Professor of Medicine

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