Forging New Fronts in Catheter Ablations for Patients With Congenital Heart Disease
Recent study findings show that nearly 20% of people living with adult congenital heart disease (ACHD) developed an arrhythmia. Surgical scar tissue is often the cause in these cases.
Whereas the typical aging population tends to develop arrhythmias in their 70s and 80s, those with adult congenital heart disease experience them much earlier, in their 40s and 50s.
Catheter ablation is an effective and reliable treatment for various types of arrhythmias, and one offered to patients—both children and adults—through the Heart Institute’s Arrhythmia and Electrophysiology (EP) Program.
Special Expertise in Adult Congenital Heart Disease Arrhythmias
“We have an intricate understanding of the complex anatomy of congenital heart disease and where the conduction system is located,” says Shankar Baskar, MD, a pediatric and congenital cardiac electrophysiologist with the Heart Institute. For the many adult patients with congenital heart disease who are now living longer than ever, catheter ablations are an important therapy in treating arrhythmias.
Baskar and his colleagues rely on their expertise in ACHD, along with a merged modeling technique using CT or MRI, to offer catheter ablations that lower the risk of arrhythmia complications and improve long-term outcomes. Here’s how:
- Merging CT and MRI with EP studies
Baskar explains: “We integrate CT and MRI results onto the EP study itself. This is especially helpful in patients who have a very complex anatomy.”
Multiple studies have shown that performing an electrophysiology procedure and ablation results in control of symptoms longer than taking medications. - Reducing the risk in patients with Tetralogy of Fallot
Baskar explains: “These patients are at high risk for sudden cardiac arrest and ventricular arrhythmias. This often resulted in them receiving implantable cardioverter defibrillators. We are now learning how catheter ablation can play an important role in these patients, and in some selected patients may be an alternative to ICD implantation.”
Performing Ablations Before Fontan Operations
On the other end of the age spectrum are young children with complex single ventricle defects facing a Fontan operation to reroute the heart’s blood flow to the lungs. Arrhythmias that develop later in life for these patients are challenging to treat. David Spar, MD, uses catheter ablations in some of these patients before their Fontan procedure to prevent a later-in-life arrhythmia. Here’s how:
- Pioneering treatment solves problem before it starts
Spar explains: “In patients with isomerism, and those who are at risk for twin AV nodes or tachycardia, we evaluate for inducible tachycardia and ablation prior. It’s known that performing ablation prior to Fontan is easier than when these patients are older.”
Ablation in this case is performed as part of a cardiac catheterization along with an MRI and EP study, so patients only need to undergo anesthesia once.
Arrhythmias in general pose a long-term risk for patients with congenital heart disease. A multidisciplinary approach with pediatric and adult care providers working together creates the optimal environment for using advanced catheter ablation methods to repair and prevent abnormal heart rhythms in this patient population.
