Catheter ablation in patients with congenital heart disease: a nationwide prospective cohort

Abstract Introduction Current evidence on catheter ablation for patients with congenital heart disease (CHD) and cardiac arrhythmias is derived from small, retrospective studies. Purpose This study aims to provide insights from a nationwide contemporary registry that seeks to enroll all congenital patients undergoing catheter ablation in France. Methods Initiated by the Institute of Health and Medical Research, this prospective study included all CHD patients referred for catheter ablation from January 2020 to July 2024 across 27 French centers. Patient characteristics, acute outcomes and recurrences during follow-up were analyzed. Results A total of 1,135 consecutive catheter ablation procedures were performed on 998 patients (mean age 46.1±16 years, 55.5% males, 5.9% under 18 years old). The primary clinical arrhythmias targeted were intra-atrial reentrant tachycardia or focal atrial tachycardia (IART/FAT) in 677 (59.6%), atrial fibrillation (AF) in 195 (17.2%), premature ventricular contraction/ventricular tachycardia (PVC/VT) in 188 (16.6%), atrioventricular reentrant tachycardia (AVRT) in 38 (3.3%), and atrioventricular nodal reentrant tachycardia (AVNRT) in 22 (1.9%), with significant variations in patterns observed based on the underlying substrate (Figure 1). Clinical arrhythmia was successfully ablated in 1,068 patients (94.1%). 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 PVC/VT (86.7%). Acute complication occurred in 43 procedures (3.8%), including 6 (0.5%) pacemaker implantations, 5 (0.4%) tamponades, 2 (0.2%) strokes, and 1 (0.1%) death. The overall 1-year and 2-year recurrence-free rates were 77.4% (95%CI 74.7-80.6%) and 68.5% (95%CI 64.8-72.4%), respectively. However, significant variations in recurrence rates were noted based on the type of arrhythmia and the underlying CHD (Figure 2). Conclusion Catheter ablation in patients with CHD demonstrates highly favorable acute outcomes and a low complications rate. However, 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.Figure 1 Figure 2