P766Catheter ablation in congenital heart disease in preparation to cardiac transplant: a single centre experience

Abstract

Introduction: Arrhythmia and heart failure (HF) are the most frequent complications throughout the long-term follow-up of patients with adult congenital heart disease (ACHD) and often coexist. representing the commonest causes of morbidity and mortality in this population. This is particularly true for patients awaiting cardiac transplantation. We report on our single centre experience of 5 patients who underwent catheter ablation procedures to manage their arrhythmia and avoid recurrent admission for arrhythmia-induced decompensation. Purpose: To demonstrate efficacy of catheter ablation to reduce arrhythmia burden and hospital admissions in patients awaiting cardiac transplantation. Methods: Five patients (3 female, mean age 47.8612.8 years, median EF of the systemic ventricle 26612%) presented with either atrial (n=3) or ventricular (n=2) arrhythmias in the presence of complex ACHD conditions (Tricuspid atresia 1 pt, Mitral Atresia 1 pt, Double Inlet Left Ventricle 1 pt, Arrhythmogenic Right Ventricular Cardiomyopathy-ARVC 1 pt, Left Ventricular Non-Compaction-LVNC 1 pt). They underwent a median of 2 ablation procedures to target a total number of 13 tachycardias. All ablations were carried out with three-dimensional electroanatomical mapping (plus remote magnetic navigation in 2 patients), merged with pre-acquired cardiac magnetic resonance or computed tomography scans. All procedures were supported by dedicated cardiac anaesthetists and occurred without any complication. 1Results: A total of 13 arrhythmia were inducible and subsequently ablated: 1 atrial fibrillation, 1 focal atrial tachycardia (AT) from the left atrium, 4 focal and 2 re-entrant AT from the right atrium (RA), 1 focal AT from the junction of the lateral tunnel graft with the RA, 4 ventricular ectopics/tachycardia either from the left or the right ventricle (2 with epicardial origin sites). Over a median follow up of 27 months (range 11 to 70), two patients underwent successful transplantation respectively 1375 and 1269 days after their last ablation procedure, having been arrhythmia free ever since. One patient passed away despite being listed on the ultra-urgent transplant list, whilst 2 patients have been ablated but are still waiting transplant at 2 different UK centers (Figure). Conclusion: Catheter ablation is a feasible tool of rhythm management in ACHD patients that await transplantation. Applying a team approach, even hemodynamically very limited patients can be ablated successfully, allowing them to remain stable enough to wait even for a substantial time period until a suitable donor is found.