Re-entry using anatomically determined isthmuses: a curable ventricular tachycardia in repaired congenital heart disease.

Circ Arrhythm Electrophysiol. 2015 Feb;8(1):102-9. doi: 10.1161/CIRCEP.114.001929. Epub 2014 Nov 24.

Re-entry using anatomically determined isthmuses: a curable ventricular tachycardia in repaired congenital heart disease.

Kapel GF1Reichlin T1Wijnmaalen AP1Piers SR1Holman ER1Tedrow UB1Schalij MJ1Stevenson WG1Zeppenfeld K2.

Comment: Adults with repaired congenital heart disease are at significant risk for late morbidity and mortality secondary to ventricular arrhythmias depending on their underlying anatomy and surgical approach.  There are several known anatomic isthmuses that are associated with re-entrant ventricular tachycardias which can be rapid and life-threatening.  ICDs are commonly used in this population and while they can be effective, they are not curative of the underlying arrhythmia and come with their own morbidities.   In this study, Kapel and colleagues assessed 34 patients who underwent CHD repair as children presenting with VT for radiofrequency ablation.  In these patients, 61 different VTs were initiated and at least one isthmus identified in all that was related to the inducible VT.  Successful ablation was performed in 25/34.  Of these 25, 18 had ICDs  and all were free of recurrence in long term follow up (46 +/- 29 months).  Seven of the 18 patients had ICD related complications (fracture, infection, inappropriate shocks, RV oversensing).  Four of the 9 unsuccessful ablation patients had recurrence of the VT.  One patient with success, but poor cardiac function received an appropriate ICD shock for VF.  These data suggest that isthmus ablation can be curative and that the risks of ICD may outweigh the benefits in successfully ablated patients with normal cardiac function.