Efficacy of catheter ablation for arrhythmia in adults with congenital heart disease: A meta-analysis of clinical outcomes

Abstract

ABSTRACT Background: Arrhythmias remain a major clinical challenge in adult congenital heart disease (aCHD), contributing significantly to increased hospitalization rates and cardiac complications, affecting over 50% of aCHD patients. Catheter ablation (CA) is regarded as a first-line therapeutic modality due to its potential for disease modification. However, concerns persist regarding its long-term efficacy and safety. Thus, a comprehensive evaluation of CA outcomes in this population is warranted. Methods: The outcomes of interest were the success rate, secondary ablation rate, complication rates, and recurrence of arrhythmias. Quality assessment was done using the Risk of Bias in Non-randomized Studies of Interventions tool, and meta-analysis was performed using RStudio. Results: A comprehensive search of seven databases yielded 15 articles for analysis, among which 10 were categorized as low-risk, four as moderate-risk, and one lacked information regarding bias. The single-arm meta-analysis, examining events per 100 observations, revealed a success rate of 85.37 (95% confidence interval [CI] =78.50, 92.24). Moreover, the secondary ablation rate was determined to be 29.29 (95% CI = 16.92, 41.66), while major complications occurred at a rate of 2.81 (95% CI = 0.89, 4.73) and minor complications at a rate of 5.29 (95% CI = 1.88, 8.70). The overall recurrence rate of arrhythmias was found to be 40.33 (95% CI = 28.37, 52.29), with specific rates for intra-atrial reentrant tachycardia at 20.33 (95% CI = 11.24, 29.43), atrial fibrillation at 14.25 (95% CI = 3.46, 25.05), and atrioventricular nodal reentrant tachycardia at 9.70 (95% CI = 0.00, 19.56). Lastly, the implantation rate of implantable cardioverter defibrilators (ICDs) was found to be 1.05 (95% CI = 0.12, 1.99). Conclusion: CA for arrhythmias in aCHD patients demonstrates high success rates with minimal procedural complications. However, the substantial recurrence rates highlight the need for ongoing monitoring and proactive strategies to optimize long-term outcomes.