Impact of intra-atrial reentrant tachycardia management on outcomes in adult patients with congenital heart disease - 06/01/20
Résumé |
Background |
Atrial arrhythmias are common complications in adults with congenital heart disease (ACHD) and are associated with a high morbidity and mortality. Intra-atrial reentrant tachycardia (IART) is the most prevalent arrhythmia in this population. This study aimed to compare outcomes according to arrhythmia management.
Methods |
All hospitalisations for IART in ACHD patients were retrospectively identified from medico-administrative database from September 2006 to September 2016. Outcomes of patients with IART managed with direct-current cardioversion (DCCV) were compared with patients referred for catheter ablation (CA). Atrial arrhythmia recurrence, death, stroke and first admission for heart failure (HF) were analyzed during follow-up.
Results |
Ninety-one ACHD patients with IART (baseline median age 38 years [IQR 29-50], male 64%, 45% moderate CHD and 41% complex CHD) were included. Median follow-up was 3 years [IQR 1.6-6.7]. Twenty-six (28.6%) patients underwent DCCV and 65 (71.4%) CA. No significant difference in CHD complexity, past medical history of atrial arrhythmia and HF were observed between the 2 groups. Patients who underwent DCCV were significantly older (43 years [IQR 34–51] vs. 36 years [IQR 26–44], P=0.03), with a higher CHADS-VASC score (CHADS-VASC ≥1 in 61% in DCCV group vs. 44% in CA group, P=0.001). Atrial arrhythmia recurrence was observed in 52% after CA and 65% after DCCV (Fig. 1A, P=0.28). Most of recurrence were IART, but atrial fibrillation was recorded in 37.5% after DCCV and 25.8% after CA (P=0.4). At the end of follow-up, patients who were initially treated by CA were more frequently in sinus rhythm (84% vs. 27%, P=0.02), with a significant lower incidence of severe cardiovascular events (Fig. 1B, P<0.01).
Conclusions |
A proactive management of IART by catheter CA is associated with better mid-term outcomes in adult patients with CHD.
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Vol 12 - N° 1
P. 168-169 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.