Elsevier

Heart Rhythm

Volume 18, Issue 11, November 2021, Pages 1852-1859
Heart Rhythm

Clinical
Ablation
Impact of specialized electrophysiological care on the outcome of catheter ablation for supraventricular tachycardias in adults with congenital heart disease: Independent risk factors and gender aspects

https://doi.org/10.1016/j.hrthm.2021.07.009Get rights and content

Background

Limited data exist on the impact of gender and specialized care on the requirement of repeat treatment of supraventricular tachycardia (SVT) in adult patients with congenital heart disease (ACHDs).

Objective

The study aimed to assess independent predictors of a combined end point of re–catheter ablation (CA) or cardioversion at 3 years of follow-up, including the impact of gender and specialized ACHD care.

Methods

All ACHDs registered in a database of one of the largest German health insurers (≈9.2 million members) who underwent CA for SVT were analyzed.

Results

Of 38,892 ACHDs 16 years or older, 485 (49.5% women; median age 58.4 years; interquartile range 42.1–70.8 years) underwent CA for SVT. Over 3-year follow-up, the number of yearly CA procedures increased significantly, particularly for atrial fibrillation (+195%) and atrial flutter (+108%). Moderate to severe complexity heart disease (odds ratio [OR] 1.66; P = .01), advanced age (OR 1.85 per year; P = .02), chronic kidney disease (OR 1.70; P = .01), and atrial fibrillation (OR 2.02; P = .002) emerged as independent predictors of retreatment. Retreatment was significantly less often performed if primary CA was carried out at a specialized CHD center (P = .009) in patients with moderate to severe complexity heart disease. Women treated in specialist centers had a 1.6-fold reduced risk of undergoing retreatment (P = .01).

Conclusion

CA for SVT is increasingly performed in ACHDs, especially for atrial flutter and atrial fibrillation. Patients with moderate and severe complexity congenital heart defects and female ACHDs benefit from upfront referral to specialized CHD centers for CA. Centralization of care for ACHD arrhythmias should thus be advocated.

Introduction

Supraventricular tachycardia (SVT) is among the leading late complications in adult patients with congenital heart disease (ACHDs). In fact, the lifetime risk of SVT in this cohort is estimated to be approximately 50% by the age of 65 years.1 Particularly in ACHDs with complex anatomy and a fragile hemodynamic balance, SVT may have a detrimental impact on morbidity and mortality including its documented association with sudden cardiac death.1,2

The objectives of this population-based study were to characterize recurrence rates of SVT after initial catheter ablation (CA) in ACHDs compared with noncongenital patients, describe patient characteristics associated with a higher risk of arrhythmia recurrence, and ascertain whether and which ACHDs benefit from referral to a specialized center dedicated to electrophysiological treatment of ACHDs.

Section snippets

Methods

Data were obtained retrospectively from the data set of the German BARMER health insurer that comprises approximately 9.2 million insurance holders (out of ≈83 million inhabitants in Germany). All diagnoses are encoded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification. Procedures are documented using the German procedure classification (OPS) codes. Prescription of drugs is encoded using Anatomical Therapeutic

Demographic data and descriptive analysis

Overall, 38,892 ACHDs 16 years or older were identified in the database during the time period from 2012 to 2015. Of these, 1.25% (n = 485 patients; 49.5% women; median age 58.4 years; IQR 42.1–70.8 years) underwent 519 initial CA procedures for SVT (patients could be counted more than once if they underwent CA for different types of SVT during the study period). The median hospital stay was 3 days (IQR 2–6 days). During the time period, 22,544 initial CA procedures were performed in 21,489

Discussion

In our population-based analysis, the total volume of primary CA increased by 38% between 2012 and 2015, supporting the notion that CA for treatment of SVT in ACHDs is gaining importance. The requirement of retreatment (CA or cardioversion) was 36% higher than in non-ACHDs, where it was 24% but still in a reasonable range for this complex population. Moderate to severe complexity CHD, advanced age, and comorbidities such as chronic kidney disease as well as AF were independent predictors of

Conclusion

CA is increasingly performed in ACHDs. Arrhythmias in this setting, however, are more complex, and ablation procedures require retreatment more often than in patients without CHD. Apart from medium to highly complex CHD, advanced age, AF, and chronic kidney disease emerged as independent predictors of retreatment, supporting the hypothesis that ACHDs benefit from an early approach for invasive electrophysiology. The present study emphasizes that patients with moderate and severe complexity

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    Funding sources: This study was conducted within the framework of the OptAHF project (Optimizing the care in Optimization of care for adults with congenital heart disease; G-BA Innovationfonds 2018). Research in the Department of Cardiology III, University Hospital Münster was supported by the Karla Völlm Emah Stiftung, Krefeld, Germany.

    Disclosures: The authors have no conflicts of interest to disclose.

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