The complexity of CHD appears to have a significant effect on a study but not in others .
Catheter ablation in ASD and persistent left superior vena cava had a high success rate .
Overall , catheter ablation is safe whichever the type of CHD is .
Conclusion Catheter ablation for AF in CHD had modest efficacy that can be increased by subsequent/repeat ablation and it also has an excellent safety profile .
Abstract Background Prevalence of atrial fibrillation ( AF ) in patients with congenital heart disease ( CHD ) is on the rise .
Anti-arrhythmic drugs are usually the first line of treatment in CHD , however , it is often ineffective and poorly tolerated .
We aim ed to perform a systematic review to assess the efficacy and safety of catheter ablation for AF in CHD .
Pulmonary vein isolation for the treatment of drug-refractory atrial fibrillation in adults with congenital heart disease.
BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia in adults with congenital heart disease ( CHD ) .  Long-term antiarrhythmic therapy ( AAT ) in these patients has significant shortcomings . The safety and efficacy of pulmonary vein antrum isolation ( PVAI ) for the treatment of AF in CHD is presently unknown . HYPOTHESIS We hypothesized that PVAI for AF in patients with CHD is effective and safe . METHODS We review ed a prospect i ve cohort of 4315 patients ( age ≥ 18 ) undergoing PVAI for drug refractory AF at a single institution and identified 36 consecutive patients with CHD ( single ventricle physiology , tetralogy of Fallot , coa rct ation of the aorta , ventricular septal defects , atrial septal defects ( ASD ) and cardiomyopathy result ing from anomalous origin of the left main coronary from the pulmonary artery ) . A second cohort of 355 consecutive patients with noncongenital structural heart disease ( NSHD ) ( coronary artery disease , valvular heart disease , ejection fraction < 50 % , or prior noncongenital cardiac surgery ) undergoing PVAI during the same time period was used as a control . Success was defined as freedom from AF starting two months after PVAI in the absence AAT until the end of follow-up . Partial success was defined as freedom from AF in the presence of AAT until the end of follow-up . Combined success was defined as the sum of success and partial success . We compared the outcomes with the use of propensity-score matching in the overall cohort . RESULTS Patients with NSHD were older and had higher prevalence of hypertension ( P < .01 ) , diabetes ( P < .01 ) and hyperlipidemia ( P < .01 ) . The most common CHD lesion was ASD ( 61 % ) and the most common NSHD lesion was valvular heart disease ( 57 % ) . After one PVAI , success was achieved in 42 % and 53 % at 300 days in the CHD and NSHD groups respectively . Four-year success was achieved in 27 % and 36 % in the CHD and NSHD groups , respectively . There were no significant differences in the success rates between patients groups ( P= .46 ) , nor were there any differences in left atrial size or changes in ejection fraction after one or two PVAI in the respective groups . Complication rates between the CHD and NSHD groups were similar ( 15 % vs. 11 % , P= .42 ) except for a higher risk of vascular site complications in patients with CHD ( 8 % vs. 1 % , P < .05 ) . CONCLUSION PVAI is an attractive treatment modality in drug refractory AF in CHD , with combined success rates in excess of 60 % . The maintenance of sinus rhythm after PVAI in CHD appears similar to that of NSHD and warrants prospect i ve validation
The complexity of CHD appears to have a significant effect on a study but not in others .
Catheter ablation in ASD and persistent left superior vena cava had a high success rate .
Overall , catheter ablation is safe whichever the type of CHD is .
Conclusion Catheter ablation for AF in CHD had modest efficacy that can be increased by subsequent/repeat ablation and it also has an excellent safety profile .
Abstract Background Prevalence of atrial fibrillation ( AF ) in patients with congenital heart disease ( CHD ) is on the rise .
Anti-arrhythmic drugs are usually the first line of treatment in CHD , however , it is often ineffective and poorly tolerated .
We aim ed to perform a systematic review to assess the efficacy and safety of catheter ablation for AF in CHD .