Predictors of arrhythmia recurrence within 12 months after catheter ablation in patients with congenital heart disease
J Malinowski, M Orczykowski, P Urbanek, R Bodalski, P Derejko, A Hasiec, G Warminski, K Dubowski, M Lipczynska, W Mazepa, M Bilinska, M Sterlinski, M Kowalski, E Warchol-Celinska, L SzumowskiAbstract
Introduction & purpose
Catheter ablation (CA) is an effective treatment for symptomatic arrhythmias in patients with congenital heart disease (CHD), improving clinical status in a particularly burdened population. This study aimed to identify predictors of 12-month arrhythmia-free survival in patients with CHD following CA.
Methods
Consecutive patients with CHD undergoing CA for arrhythmia were retrospectively included. Baseline clinical, procedural, and follow-up data, along with echocardiography, chest X-ray, and blood test results, were collected. Ablation efficacy was assessed over 12 months using device interrogation, electrocardiogram (ECG), or Holter ECG during routine evaluations or unscheduled visits. Acute success was defined as termination of the clinical arrhythmia with non-inducibility at the procedure’s end, and long-term success as the absence of clinical arrhythmia during follow-up. Patients were categorised according to the presence or absence of arrhythmia recurrence.
Results
The study group consisted of 223 patients (120 males) with a median age of 38.6 years (interquartile range [IQR] 29.0–51.6). The types of CHD and the history of CHD correction are presented in Figure 1. Procedures were performed between September 2008 and September 2024. General characteristics, procedural details, and follow-up data are summarised in Table 1. Arrhythmia recurrence within 12 months was observed in 46 patients (20.6%), with a median time to recurrence of 3.2 months (IQR 1.2–7.2). Significant (p < 0.05) predictors of recurrence identified in the univariate Cox proportional hazards model included a systemic right ventricle (RV), congenitally corrected transposition of the great arteries (cc-TGA), atrial fibrillation (AF), and serum total bilirubin level, whereas atrial tachycardia was a negative predictor. Two multivariate Cox proportional hazards models (p < 0.02) were constructed using non-collinear significant predictors. The first model (Chi² = 14.27; Harrell’s C-index = 0.615) included AF and a systemic RV, with hazard ratios (95% confidence intervals) of 3.71 (1.34–10.26) and 27.05 (3.62–202.19), respectively. The second model (Chi² = 8.09; Harrell’s C-index = 0.605) included cc-TGA and total bilirubin level, with hazard ratios of 12.11 (1.07–137.51) and 1.06 (1.01–1.11), respectively. The Kaplan-Meier analysis confirmed that a total bilirubin level >2 mg/dL was associated with clinical arrhythmia recurrence (log-rank test, p = 0.004). No patient deaths occurred during follow-up.
Conclusion
In our single-centre study, we demonstrated that CA is a feasible and effective treatment for cardiac arrhythmias in patients with CHD, achieving high 1-year success and low recurrence rates. Recurrence was mainly predicted by a systemic RV, particularly in cc-TGA, and by arrhythmia type, with AF showing the highest recurrence. A baseline serum total bilirubin level above 2 mg/dL also emerged as a strong independent predictor.