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Background: There are limited data about outcomes of preoperative electrophysiology studies (EPS) in patients with Ebstein Anomaly.
Methods: This is a descriptive study of all adults (>18 years) that underwent preoperative EPS at Mayo Clinic, 2000-2014. Data from clinic notes, EPS, and surgical notes were reviewed. Study objective was to determine outcomes of preoperative EPS in this population.
Results: Preoperative EPS were performed in 41 patients; mean age 43±15 year, males 23 (56%). All had a history of palpitations; 12/41 (29%) had a prior cardiac surgery, and 9 of which were tricuspid valve (TV) surgeries. A documented arrhythmia was present in 29/41 (71%), and these arrhythmias were atrial flutter in 4, atrial fibrillation in 1, ectopic atrial tachycardia (EAT) in 2, Wolf Parkinson White syndrome in 14, and other types of supraventricular tachycardia in 8.
Catheter ablation was performed at the time of EPS in 13/41 (32%), and these ablations were for EAT in 2, atrial flutter in 4, accessory pathway mediated tachycardia in 8, and slow pathway modification in 4. All patients underwent surgery (TV repair n=29 and TV replacement n=12), and there was 1 perioperative death. Concomitant surgical arrhythmia procedures were performed in 32/41 (78%) and these procedures were right atrial maze in 25; biatrial maze in 6; and division of accessory pathway in 1. Antiarrhythmic drugs and anticoagulation were discontinued after 3 months postoperative in 31 patients.
Follow-up data were available in 38, and arrhythmia recurrence (AR) occurred in 14/38 patients (37%) within 49±14months of follow-up. Freedom from AR was 78% at 36 months, and there was no difference between the catheter ablation group vs the arrhythmia surgery group, 77% vs 78%, P=.65.
Conclusions: Outcomes of catheter ablation during preoperative EPS was comparable to surgical arrhythmia therapy on mid-term follow-up. A larger cohort with a control arm will be required to evaluate the role of preoperative EPS in this population.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovations in Pediatric Catheterization and EP: Mending, Fixing and Predicting
Abstract Category: 11. Congenital Heart Disease: Therapy
Presentation Number: 1144-023
- 2017 American College of Cardiology Foundation