AFib ablation strategies for ‘normal’ hearts also work for CHD survivors

Atrial fibrillation (AFib) ablation techniques used on individuals without cardiac abnormalities can be safely applied to adults with congenital heart disease (CHD), according to a new study in JACC: Clinical Electrophysiology. But in many cases, multiple ablation procedures are needed to boost the chances of arrhythmia-free survival.

Christian Sohns, MD, with Heart Center Bremen in Germany, and colleagues studied outcomes from 57 consecutive adults with CHD who developed AFib and were resistant to antiarrhythmic drugs. After a median of 41 months of follow-up, estimates for arrhythmia-free survival at one and five years post-ablation were 63 percent and 22 percent, respectively. However, after subsequent ablation procedures, those estimates significantly improved to 99 percent at one year and 83 percent at five years.

“AFib ablation strategies established in patients with structurally normal hearts can be transferred to the inhomogeneous ACHD (adults with congenital heart disease) population and can achieve remarkable mid- to long-term results,” Sohns et al. wrote. “Different types of congenital cardiac malformations with variant heterogeneous and individual arrhythmogenic pre-conditions may account for the trend toward a higher reablation rate. AFib ablation in ACHD might be considered as a therapeutic cornerstone and bears the potential to slow down the progression of the underlying CHD and the resulting symptoms.”

The authors suggested AFib ablation procedures for this challenging population should be reserved for centers with highly specialized teams experienced in treating adults with CHD. They pointed out that population is growing due to improvements in pediatric cardiac surgery and intensive care.

“The presence or development of AFib is one of the consequences to be ‘paid’ for this pleasant process and our data demonstrate that AFib ablation in ACHD is safe and effective,” Sohns and coauthors wrote.

Even though the study is the largest of its kind, the researchers acknowledged their patient numbers were relatively low. They also couldn’t guarantee their process of periodic Holter monitoring and clinical evaluation captured every AFib episode during follow-up, leaving open the possibility that arrhythmias were underestimated.