Abstract 5712: Pulmonary Vein Antral Isolation is Effective for the Treatment of Drug Refractory Atrial Fibrillation in Adults with Congenital Heart Disease
Background: Atrial fibrillation (AF) is a common arrhythmia in adults with congenital heart disease (CHD). Anti-arrhythmic therapy (AAT) has significant shortcomings. The safety and efficacy of pulmonary vein antrum isolation (PVAI) for the treatment of AF in CHD is unknown. Hypothesis: We tested the hypothesis 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 and identified 40 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 artery from the pulmonary artery). A second cohort of 355 consecutive patients with acquired heart disease (coronary artery disease, valvular heart disease, ejection fraction <50% or prior non-congenital cardiac surgery) undergoing PVAI during the same time period were used as a control group to assess for differences in procedural success. All patients were followed for recurrence of AF with transtelephonic, Holter and event monitoring, and office visits. Procedural success was defined as freedom from AF two months after PVAI in the absence AAT until the end of follow-up.
Results: Patients with acquired heart disease (AHD) were older (57 yrs vs. 52 yrs, p<0.001) and had higher prevalence of hypertension (59% vs. 40%, p<0.001), diabetes (35% vs. 1%, p<0.001) and hyperlipidemia (53% vs. 35%, p<0.001). The most common lesion in CHD was ASD (63%) and the most common AHD lesion was valvular heart disease (57%). The mean duration of follow-up was 18 months. There was no significant difference in the success rate after 1st PVAI in patients with CHD and AHD (52% vs. 57%, p=0.27). Likewise, there was no significant difference in the success rate after 2nd PVAI attempts in patients with CHD and AHD (65% vs. 70%, p=0.52). The total complication rate was similar in patients with CHD and AHD (15% vs. 10%, p=0.42).
Conclusion: PVAI is an attractive treatment modality for drug refractory AF in CHD, with success rates in excess of 50%. The maintenance of sinus rhythm after PVAI in the CHD group is similar to those with AHD and warrants prospective validation.