Open access

Empirical Cavotricuspid Isthmus Ablation in Congenital Heart Disease: A Nationwide Prospective Study.

Geoffroy Ditac Francis Bessière G. Duthoit J. Pasquié L. Champ-Rigot Mathieu Albertini F. Anselme S. Bartoletti Damien Bonnet C. Bredy S. Bun G. Clerici A. da Costa C. de Chillou P. Defaye M. de Guillebon C. Davril Antoine Delinière N. Derval Nabil Dib L. Donisi K. Gardey Caroline Ghanimé J. Gourraud S. Hascöet N. Hammache R. Hénaine L. Iserin P. Jacon F. Jourda C. Karsenty Paul Khairy L. Koutbi G. Laurent Baptiste Maille A. Maltret J. Mansourati N. Marimpouy Raphael Martins P. Maury A. Milhem P. Moceri P. Ollitrault Pauline Pinon O. Piot Karim Benali Kahina Racelma R. Richard-Vitton Frédéric Sacher F. Sebag M. Tortigue S. Venier M. Wilkin P. Winum Eloi Marijon Nicolas Combes Victor Waldmann

Sep 2026 · JACC Clinical Electrophysiology · 0 citations · 31 references

Medicine

Abstract

Background

Recurrence rates of atrial arrhythmias after catheter ablation in patients with congenital heart disease (CHD) remain substantial. Given the high prevalence of peritricuspid flutter, systematic cavotricuspid isthmus (CTI) ablation may represent a rational preventive strategy.

Objectives

The objective of this study was to assess the impact of empirical CTI ablation in CHD patients.

Methods

This prospective nationwide study included all CHD patients referred for a first catheter ablation of an atrial arrhythmia between 2020 and 2024. Empirical ablation comprised probabilistic (noninducible arrhythmia with prior documentation) and prophylactic (no prior documentation) ablation. The primary endpoint was freedom from any atrial arrhythmia recurrence. Secondary endpoints included arrhythmia-related hospitalizations, redo ablations, and complications.

Results

Among 575 patients undergoing a first catheter ablation for atrial arrhythmia, 345 (60.0%) had CTI-dependent flutter. The remaining 230 patients formed the study population (mean age: 48.2 ± 16.4 years; 50.9% male). CHD complexity was predominantly moderate (57.4%). Targeted arrhythmias were atrial macro-re-entry (53.0%), atrial fibrillation (47.0%), and focal atrial tachycardia (17.4%), with multiple arrhythmias in 16.5%. Empirical CTI ablation was performed in 71 patients (30.9%) and was associated with significantly higher freedom from any atrial arrhythmia at 1 year (78.1% vs 65.6%, P = 0.010) and 2 years (71.2% vs 56.1%, P = 0.025), remaining independently associated with lower risk of recurrence after multivariable adjustment (HR: 0.47, 95% CI: 0.24-0.92, P = 0.027). This benefit was primarily observed in patients without atrial fibrillation history (interaction P = 0.005). Arrhythmia-related hospitalization was also significantly reduced (14.1% vs 25.8%, P = 0.048).

Conclusions

Empirical CTI ablation is associated with improved freedom from atrial arrhythmia and reduced rehospitalization in CHD patients.

DOI PubMed Semantic Scholar

Read PDF