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PE-482887-002 TRANSBAFFLE AND TRANSCONDUIT ACCESS FOR CATHETER ABLATION OF ATRIAL TACHYARRHYTHMIA IN ADULTS WITH FONTAN PALLIATION: A PEDIATRIC AND ADULT CONGENITAL ELECTROPHYSIOLOGY SOCIETY AND INTERNATIONAL SOCIETY OF ADULT CONGENITAL HEART DISEASE MULTICENTER STUDY
Abstract   Peer reviewed

PE-482887-002 TRANSBAFFLE AND TRANSCONDUIT ACCESS FOR CATHETER ABLATION OF ATRIAL TACHYARRHYTHMIA IN ADULTS WITH FONTAN PALLIATION: A PEDIATRIC AND ADULT CONGENITAL ELECTROPHYSIOLOGY SOCIETY AND INTERNATIONAL SOCIETY OF ADULT CONGENITAL HEART DISEASE MULTICENTER STUDY

Anna N. Kamp, Paul Khairy, Victoria Shay, Chance Alvarado, Francis Bessiere, Scott R. Ceresnak, Benjamin Hale, Martin J. LaPage, Thomas A. Pilcher, Philip M. Chang, …
Heart rhythm, Vol.21(5 Supplement), pp.S39-S39
05/2024
DOI: 10.1016/j.hrthm.2024.03.328

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Abstract

Background Atrial tachyarrhythmia (AT) is a common late manifestation after Fontan palliation and catheter ablation is often recommended. Transbaffle or transconduit access (TBA) to treat AT in adults with Fontan palliation has not been broadly evaluated. Objective Evaluate multicenter outcomes of TBA for catheter ablation in adults with total cavopulmonary connection (TCPC) Fontan. Methods A retrospective multi-center study including consecutive TCPC Fontan patients >18 years of age undergoing TBA procedures for catheter ablation of AT between 2012 – 2022 was performed. Study data, including operative history, procedural details, acute outcomes, and clinical follow-up were transferred to the coordinating center via the REDCap data collection tool. Measured outcomes included: 1) successful ablation of AT and 2) complications. Wilcoxon rank sum test and Fisher’s exact test were used to assess between-group differences. Results Data from 117 TCPC Fontan procedures with TBA were collected, including 85 lateral tunnel (LT), 30 extracardiac conduit (EC), and 2 intra-cardiac conduit Fontans. Median age at ablation was 28 years (IQR 24,33). Most patients had mild systemic ventricular dysfunction (83, 71%) and mild AV valve regurgitation (85,73%). Most (80, 68%) had ablation for AT refractory to antiarrhythmic drugs. TBA was performed by an electrophysiologist in 104 (89%) and interventional cardiologist in 13 (11%). Primary imaging included fluoroscopy in 98 (78%), TEE in 28 (22%), and intracardiac echo in 27 (22%). The targeted arrhythmia was most commonly intra-atrial reentry tachycardia in 78 (67%). Successful ablation was achieved in 85 (91%) for LT versus 22 (92%%) for EC. There was no difference in procedure time between those with LT (273mins [224, 353]) compared to ECC (266 mins [211, 366]) Fontan, (p=0.7). There were 5 complications for LT (5.9%; CVA, vascular injury, cardiac perforation not requiring intervention, acute drop in Hgb of uncertain etiology, and dislodgement of atrial pacing lead) and 3 for EC Fontan (10%; transient AV block, hemodynamically unstable AT, and hemopneumothorax) without a significant difference between groups (p=0.4). Conclusion Transbaffle puncture for ablation of atrial arrhythmias in adults with TCPC Fontan can be performed safely and effectively. Despite TBA complexity, electrophysiologists were able to perform most with no difference in complication rate between LT and EC Fontan patients.

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