Catheter ablation in congenital heart diseases: a French nationwide study
Victor Waldmann, Guillaume Duthoit, Jean-Luc Pasquié, Laure Champ‐Rigot, Mathieu Albertini, Frédéric Anselme, Stefano Bartoletti, Damien Bonnet, Charlène Bredy, Sok‐Sithikun Bun, Gaël Clerici, Antoine Da Costa, Christian de Chillou, Pascal Defaye, Maxime De Guillebon, Clément Davril, Antoine Delinière, Nicolas Derval, Geoffroy Ditac, Kévin Gardey, Caroline Ghanimé, Jean‐Baptiste Gourraud, Sébastien Hascoët, Néfissa Hammache, Roland Hénaine, Laurence Iserin, Peggy Jacon, Frédéric Jourda, Clément Karsenty, Linda Koutbi, Gabriel Laurent, Baptiste Maille, Alice Maltret, Jacques Mansourati, Nathan Marimpouy, Raphaël P. Martins, Philippe Maury, Antoine Milhem, Pamela Moceri, Pierre Ollitrault, Pauline Pinon, Olivier Piot, Robin Richard-Vitton, Frédéric Sacher, F. Sébag, Marine Tortigue, Sandrine Venier, Marie Wilkin, Pierre Winum, Eloi Marijon, Nicolas Combes, Francis Bessière
Abstract
BACKGROUND AND AIMS: Current evidence on catheter ablation for patients with congenital heart disease (CHD) is derived from small, retrospective studies. This study aims to provide insights from a nationwide contemporary registry. METHODS: This prospective study included all CHD patients referred for catheter ablation from 2020 to July 2024 across 28 French centres. The primary outcome was the rate of per-procedural acute success. Secondary outcomes included complications as well as freedom from arrhythmia recurrence. RESULTS: A total of 1135 consecutive catheter ablation procedures were performed in 998 patients (mean age 46.1 ± 16 years, 55.5% male). The main primary clinical arrhythmias targeted were atrial flutter/tachycardia in 677 (59.6%), atrial fibrillation in 195 (17.2%), ventricular arrhythmia in 188 (16.6%), and atrioventricular reentrant tachycardia in 38 (3.3%), with significant variations in patterns observed based on the underlying substrate. Clinical arrhythmia was successfully ablated in 1071 patients (94.4%). The mean number of arrhythmias targeted per procedure was 1.5 ± 0.7, with overall acute success rates exceeding 90% for all arrhythmias except for ventricular arrhythmias (86.7%). Acute complication occurred in 43 procedures (3.8%), including 1 (0.1%) death. The overall 1- and 2-year recurrence-free rates were 77.3% (95% confidence interval 74.2%-80.4%) and 68.4% (95% confidence interval 64.7%-72.3%), respectively. Significant variations in recurrence rates were noted based on the type of arrhythmia and the underlying CHD. CONCLUSIONS: Catheter ablation in patients with CHD demonstrates highly favourable acute outcomes and a low complication rate. Recurrence rates during follow-up vary depending on the targeted arrhythmia and the underlying CHD. These findings should be considered in the benefit-risk assessment.