Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease
Background. Adults with congenital heart disease (ACHD) are often affected by cardiac arrhythmias requiring catheter ablation. Catheter ablation in this setting represents the treatment of choice but is flawed by frequent recurrencies. Predictors of arrhythmia relapse have been identified, but the r...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/4/168 |
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| author | Francesco Perna Alessandro Telesca Roberto Scacciavillani Maria Lucia Narducci Gianluigi Bencardino Gaetano Pinnacchio Francesco Raffaele Spera Rocco Sabarese Gianluca Comerci Gemma Pelargonio |
| author_facet | Francesco Perna Alessandro Telesca Roberto Scacciavillani Maria Lucia Narducci Gianluigi Bencardino Gaetano Pinnacchio Francesco Raffaele Spera Rocco Sabarese Gianluca Comerci Gemma Pelargonio |
| author_sort | Francesco Perna |
| collection | DOAJ |
| description | Background. Adults with congenital heart disease (ACHD) are often affected by cardiac arrhythmias requiring catheter ablation. Catheter ablation in this setting represents the treatment of choice but is flawed by frequent recurrencies. Predictors of arrhythmia relapse have been identified, but the role of cardiac fibrosis in this setting has not been investigated. The aim of this study was to determine the role of the extension of cardiac fibrosis, detected by electroanatomical mapping, in predicting arrhythmia recurrencies after ablation in ACHD. Materials and Methods. Consecutive patients with congenital heart disease and atrial or ventricular arrhythmias undergoing catheter ablation were enrolled. An electroanatomical bipolar voltage map was performed during sinus rhythm in each patient and bipolar scar was assessed according to the current literature data. During follow-up, arrhythmia recurrences were recorded. The relationship between the extent of myocardial fibrosis and arrhythmia recurrence was assessed. Results. Twenty patients underwent successful catheter ablation of atrial (14) or ventricular (6) arrhythmias, with no inducible arrhythmia at the end of the procedure. During a median follow-up period of 207 weeks (IQR 80 weeks), eight patients (40%; five atrial and three ventricular arrhythmias) had arrhythmia recurrence. Of the five patients undergoing a second ablation, four showed a new reentrant circuit, while one patient had a conduction gap across a previous ablation line. The extension of the bipolar scar area (HR 1.049, CI 1.011–1.089, <i>p</i> = 0.011) and the presence of a bipolar scar area >20 cm<sup>2</sup> (HR 6.101, CI 1.147–32.442, <i>p</i> = 0.034) were identified as predictors of arrhythmia relapse. Conclusion. The extension of the bipolar scar area and the presence of a bipolar scar area >20 cm<sup>2</sup> can predict arrhythmia relapse in ACHD undergoing catheter ablation of atrial and ventricular arrhythmias. Recurrent arrhythmias are often caused by circuits other than those previously ablated. |
| first_indexed | 2024-03-11T04:54:22Z |
| format | Article |
| id | doaj.art-bd41e11d643f4e5a88f35383b387fa45 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-11T04:54:22Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-bd41e11d643f4e5a88f35383b387fa452023-11-17T19:47:45ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-04-0110416810.3390/jcdd10040168Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart DiseaseFrancesco Perna0Alessandro Telesca1Roberto Scacciavillani2Maria Lucia Narducci3Gianluigi Bencardino4Gaetano Pinnacchio5Francesco Raffaele Spera6Rocco Sabarese7Gianluca Comerci8Gemma Pelargonio9Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, ItalyDepartment of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, ItalyDepartment of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, ItalyCardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, ItalyCardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, ItalyCardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, ItalyCardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, ItalyDepartment of Cardiovascular Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, ItalyCardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, ItalyCardiac Arrhythmia Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, ItalyBackground. Adults with congenital heart disease (ACHD) are often affected by cardiac arrhythmias requiring catheter ablation. Catheter ablation in this setting represents the treatment of choice but is flawed by frequent recurrencies. Predictors of arrhythmia relapse have been identified, but the role of cardiac fibrosis in this setting has not been investigated. The aim of this study was to determine the role of the extension of cardiac fibrosis, detected by electroanatomical mapping, in predicting arrhythmia recurrencies after ablation in ACHD. Materials and Methods. Consecutive patients with congenital heart disease and atrial or ventricular arrhythmias undergoing catheter ablation were enrolled. An electroanatomical bipolar voltage map was performed during sinus rhythm in each patient and bipolar scar was assessed according to the current literature data. During follow-up, arrhythmia recurrences were recorded. The relationship between the extent of myocardial fibrosis and arrhythmia recurrence was assessed. Results. Twenty patients underwent successful catheter ablation of atrial (14) or ventricular (6) arrhythmias, with no inducible arrhythmia at the end of the procedure. During a median follow-up period of 207 weeks (IQR 80 weeks), eight patients (40%; five atrial and three ventricular arrhythmias) had arrhythmia recurrence. Of the five patients undergoing a second ablation, four showed a new reentrant circuit, while one patient had a conduction gap across a previous ablation line. The extension of the bipolar scar area (HR 1.049, CI 1.011–1.089, <i>p</i> = 0.011) and the presence of a bipolar scar area >20 cm<sup>2</sup> (HR 6.101, CI 1.147–32.442, <i>p</i> = 0.034) were identified as predictors of arrhythmia relapse. Conclusion. The extension of the bipolar scar area and the presence of a bipolar scar area >20 cm<sup>2</sup> can predict arrhythmia relapse in ACHD undergoing catheter ablation of atrial and ventricular arrhythmias. Recurrent arrhythmias are often caused by circuits other than those previously ablated.https://www.mdpi.com/2308-3425/10/4/168adult with congenital heart diseasecatheter ablationfibrosisarrhythmiaselectroanatomical mapping |
| spellingShingle | Francesco Perna Alessandro Telesca Roberto Scacciavillani Maria Lucia Narducci Gianluigi Bencardino Gaetano Pinnacchio Francesco Raffaele Spera Rocco Sabarese Gianluca Comerci Gemma Pelargonio Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease Journal of Cardiovascular Development and Disease adult with congenital heart disease catheter ablation fibrosis arrhythmias electroanatomical mapping |
| title | Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease |
| title_full | Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease |
| title_fullStr | Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease |
| title_full_unstemmed | Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease |
| title_short | Clinical Impact of Cardiac Fibrosis on Arrhythmia Recurrence after Ablation in Adults with Congenital Heart Disease |
| title_sort | clinical impact of cardiac fibrosis on arrhythmia recurrence after ablation in adults with congenital heart disease |
| topic | adult with congenital heart disease catheter ablation fibrosis arrhythmias electroanatomical mapping |
| url | https://www.mdpi.com/2308-3425/10/4/168 |
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