title: Pulmonary vein isolation for the treatment of drug-refractory atrial fibrillation in adults with congenital heart disease. Catheter ablation of atrial fibrillation in patients with atrial septal defect: long-term follow-up results Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: a feasibility, safety, and efficacy study. Natural History and Clinical Predictors of Atrial Tachycardia in Adults With Congenital Heart Disease
abstract: BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia in adults with congenital heart disease ( CHD ) .  Long-term antiarrhythmic therapy ( AAT ) in these patients has significant shortcomings . The safety and efficacy of pulmonary vein antrum isolation ( PVAI ) for the treatment of AF in CHD is presently unknown . HYPOTHESIS We hypothesized that PVAI for AF in patients with CHD is effective and safe . METHODS We review ed a prospect i ve cohort of 4315 patients ( age ≥ 18 ) undergoing PVAI for drug refractory AF at a single institution and identified 36 consecutive patients with CHD ( single ventricle physiology , tetralogy of Fallot , coa rct ation of the aorta , ventricular septal defects , atrial septal defects ( ASD ) and cardiomyopathy result ing from anomalous origin of the left main coronary from the pulmonary artery ) . A second cohort of 355 consecutive patients with noncongenital structural heart disease ( NSHD ) ( coronary artery disease , valvular heart disease , ejection fraction < 50 % , or prior noncongenital cardiac surgery ) undergoing PVAI during the same time period was used as a control . Success was defined as freedom from AF starting two months after PVAI in the absence AAT until the end of follow-up . Partial success was defined as freedom from AF in the presence of AAT until the end of follow-up . Combined success was defined as the sum of success and partial success . We compared the outcomes with the use of propensity-score matching in the overall cohort . RESULTS Patients with NSHD were older and had higher prevalence of hypertension ( P < .01 ) , diabetes ( P < .01 ) and hyperlipidemia ( P < .01 ) . The most common CHD lesion was ASD ( 61 % ) and the most common NSHD lesion was valvular heart disease ( 57 % ) . After one PVAI , success was achieved in 42 % and 53 % at 300 days in the CHD and NSHD groups respectively . Four-year success was achieved in 27 % and 36 % in the CHD and NSHD groups , respectively . There were no significant differences in the success rates between patients groups ( P= .46 ) , nor were there any differences in left atrial size or changes in ejection fraction after one or two PVAI in the respective groups . Complication rates between the CHD and NSHD groups were similar ( 15 % vs. 11 % , P= .42 ) except for a higher risk of vascular site complications in patients with CHD ( 8 % vs. 1 % , P < .05 ) . CONCLUSION PVAI is an attractive treatment modality in drug refractory AF in CHD , with combined success rates in excess of 60 % . The maintenance of sinus rhythm after PVAI in CHD appears similar to that of NSHD and warrants prospect i ve validation Introduction Atrial fibrillation ( AF ) is commonly found in patients with structural heart disease ( SHD ) , including atrial septal defect ( ASD ) . The feasibility and safety of ablation for AF in patients with unrepaired ASD is seldom reported . Objectives This study aims to evaluate and compare the long-term efficacy of  AF ablation  in patients with and without ASD . Methods From January 2008 to December 2012 , 18 consecutive patients were identified with medically refractory AF and an unrepaired ASD under catheter ablation .  For each ASD patient , four control subjects were matched from our data base . Results There were no significant differences between groups in terms of age , sex , type of AF , LA diameter , LVIDD , and EF . The mean procedural and fluoroscopy times were not different between the groups ( p = NS ) . After a median follow-up of 20 months , the patients in the ASD group had 44.4 % AF recurrence after a single procedure compared with 34.7 % in the control group ( p = 0.11 ) . The mean LA diameter in non-recurrent patients was smaller than in recurrent patients ( p = 0.03 ) . In univariate Cox proportional hazards analyses , the factor found to have a significant association with arrhythmia recurrences was left atrial diameter ( hazard ratio 1.059 , 95 % confidence interval 1.002 to 1.120 , p = 0.03 ) . Conclusions These results indicate that in patients with AF and an ASD amenable to percutaneous closure , a staged approach with radiofrequency ablation of AF preceding closure is a rational strategy UNLABELLED Intracardiac Echo-Guided Radiofrequency Catheter . INTRODUCTION Patients with atrial septal defect ( ASD ) are at higher risk for  atrial fibrillation ( AF )  even after repair . Transseptal access in these patients is perceived to be difficult . We describe the feasibility , safety , and efficacy of pulmonary vein antral isolation ( PVAI ) in these patients . METHOD We prospect ively compared  post-ASD/patent foramen ovale ( PFO ) repair patients ( group I , n = 45 ) with age-gender-AF type matched controls ( group II , n = 45 ) . All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography ( ICE ) . The short-term ( 3 months ) and long-term ( 12 month ) failure rates were assessed . RESULTS In group I , 23 ( 51 % ) had percutaneous closure devices and 22 ( 49 % ) had a surgical closure . There was no significant difference between group I and II in the baseline characteristics . Intracardiac echo-guided double transseptal access was obtained in 98 % of patients in group I and in 100 % of patients in group II . PVAI was performed in all patients , with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II . Over a mean follow-up of 15 + /- 4 months , group I had higher short-term ( 18 % vs 13 % , P = 0.77 ) and long-term recurrence ( 24 % vs 18 % , P = 0.6 ) than group II . There was no significant difference in the perioperative complications between the two groups . Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II , which resolved at 12 months . CONCLUSION Percutaneous AF ablation using double transseptal access is feasible , safe , and efficacious in patients with ASD and PFO repairs Background Atrial tachycardias ( ATs ) are a significant source of morbidity in adults with congenital heart disease ( CHD ) . This study evaluates the incidence and clinical predictors of AT in a cohort of patients with CHD . Methods and Results We included 3311 adults ( median age at entry 22.6 years , 50.6 % males ) with CHD ( 49 % simple , 39 % moderate , and 12 % complex ) prospect ively followed up in a tertiary center for 37 607 person-years . Predictors of AT were identified by multivariable Cox regression analysis accounting for left truncation . An external validation was performed in a contemporary cohort of 1432 patients . Overall , 153 ( 4.6 % ) patients presented AT .  AT burden was highest in complex CHD , such as single ventricle ( 22.8 % ) and D-transposition of the great arteries ( 22.1 % ) . Hazard rates of AT across lifetime , age at presentation , and the time lapse between surgery and the first AT episode varied among the most common CHD . Independent risk factors for developing AT were univentricular physiology , previous intracardiac repair , systemic right ventricle , pulmonary hypertension , pulmonary regurgitation , pulmonary atrioventricular valve regurgitation , pulmonary and systemic ventricular dysfunction . At the age of 40 years , AT-free survival in patients with 0 , 1 , 2 , and ≥3 risk factors was 100 % , 94 % , 76 % , and 50 % , respectively . These findings were confirmed in the validation cohort . Conclusions Natural history of AT differed among the most common forms of CHD . Simple clinical parameters , easily obtained by noninvasive means , were independent predictors of AT in adults with CHD . Although risk was negligible in patients without any of these factors , their addition progressively increased AT burden
target: The complexity of CHD appears to have a significant effect on a study but not in others .
  Catheter ablation in ASD and persistent left superior vena cava had a high success rate .
  Overall , catheter ablation is safe whichever the type of CHD is .
  Conclusion Catheter ablation for AF in CHD had modest efficacy that can be increased by subsequent/repeat ablation and it also has an excellent safety profile .
background: Abstract Background Prevalence of atrial fibrillation ( AF ) in patients with congenital heart disease ( CHD ) is on the rise .
  Anti-arrhythmic drugs are usually the first line of treatment in CHD , however , it is often ineffective and poorly tolerated .
  We aim ed to perform a systematic review to assess the efficacy and safety of catheter ablation for AF in CHD .