Pulmonary Vein and Left Atrial Posterior Wall Isolation for the Treatment of Atrial Fibrillation: Comparable Outcomes for Adults with Congenital Heart Disease

Objective: To assess outcomes of pulmonary vein isolation (PVI) ± left atrial (LA) posterior wall isolation (PWI) for adults with congenital heart disease (ACHD) and atrial fibrillation (AF).

Background: Optimal treatment strategies for ACHD with AF are unknown.

Methods: A retrospective review of all cryoballoon (CB) PVI ± PWI procedures at a single center over a 3-year period was performed. Clinical characteristics and outcomes for patients with and without ACHD were compared. The primary outcome was occurrence of atrial tachyarrhythmia at 12-months post ablation after a 90-day blanking period.

Results: Three-hundred sixteen patients (mean 63 ± 12 y, 63% male) underwent CB PVI ± PWI during the study, including 31 (10%) ACHD (simple 35%, moderate 39% and complex 26%; non-paroxysmal AF in 52%). ACHD were younger (51 vs 64 y, p<0.001) with lower CHADS2 DS2 -VASc score (1.2 vs 2.1, p=0.001) but had greater LA diameter (4.9 vs 4.0 cm, p<0.001) and number of prior cardioversions (0.9 vs 0.4, p<0.001) vs controls. 12-month freedom from recurrent AF was similar for ACHD and controls (76% vs 80%, p=0.6) and remained non-significant in multivariate analysis (HR 1.8, 95%CI 0.7 – 5.1; p=0.22). At 12 months post ablation, 75% of ACHD vs 93% of control patients were off antiarrhythmic drug therapy (p=0.07).

Conclusion: This study demonstrates younger age and lower conventional stroke risk, yet clinically-advanced AF for ACHD relative to controls. CB PVI ± PWI was an effective strategy for treatment of AF among all forms of ACHD with similar 12-month outcomes as compared to controls.