EP Fellows Curriculum: Catheter Ablation in ACHD-EP Fellows Curriculum: Catheter Ablation in ACHD

Video Transcription

Video Summary

The speaker discussed catheter ablation in adult congenital heart disease. The majority of catheter ablation procedures in congenital heart disease are for supraventricular tachycardia and mostly atrial arrhythmias. Atrial arrhythmias are a major problem in the adult congenital heart disease population and are associated with increases in morbidity and mortality. The most common sites for ablation in congenital heart disease are the supraventricular cava-inferior cava isthmus, the AV valve annulus, and the patch from right atrium to pulmonary artery. Patients with Transposition of the Great Arteries after the Musel Seining operation, Univentricular hearts, and Epstein's anomaly have a high incidence of supraventricular arrhythmias. In Epstein's anomaly, there is often a prominent muscular ridge along the true annulus that can contain accessory connections. Physiologic pacing is underutilized in adult congenital heart disease, but may be beneficial for preserving ventricular function and reducing heart failure. Overall, catheter ablation can be challenging in patients with adult congenital heart disease due to altered anatomy, scar tissue, and the presence of multiple arrhythmia mechanisms.

Keywords

catheter ablation

adult congenital heart disease

atrial arrhythmias

morbidity

mortality

supraventricular cava-inferior cava isthmus

AV valve annulus

Transposition of the Great Arteries

physiologic pacing