Empirical Cavotricuspid Isthmus Ablation in Congenital Heart Disease: A Nationwide Prospective Study
Abstract
BACKGROUND Recurrence rates of atrial arrhythmias after catheter ablation in patients with congenital heart disease (CHD) remain substantial. Given the high prevalence of peritricuspid flutter, systematic cavotricuspid isthmus (CTI) ablation may represent a rational preventive strategy. OBJECTIVES The objective of this study was to assess the impact of empirical CTI ablation in CHD patients. METHODS This prospective nationwide study included all CHD patients referred for a first catheter ablation of an atrial arrhythmia between 2020 and 2024. Empirical ablation comprised probabilistic (noninducible arrhythmia with prior documentation) and prophylactic (no prior documentation) ablation. The primary endpoint was freedom from any atrial arrhythmia recurrence. Secondary endpoints included arrhythmia-related hospitalizations, redo ablations, and complications. RESULTS Among 575 patients undergoing a first catheter ablation for atrial arrhythmia, 345 (60.0%) had CTI- dependent flutter. The remaining 230 patients formed the study population (mean age: 48.2 ± 16.4 years; 50.9% male). CHD complexity was predominantly moderate (57.4%). Targeted arrhythmias were atrial macro-re-entry (53.0%), atrial fibrillation (47.0%), and focal atrial tachycardia (17.4%), with multiple arrhythmias in 16.5%. Empirical CTI ablation was performed in 71 patients (30.9%) and was associated with significantly higher freedom from any atrial arrhythmia at 1 year (78.1% vs 65.6%, P = 0.010) and 2 years (71.2% vs 56.1%, P = 0.025), remaining independently associated with lower risk of recurrence after multivariable adjustment (HR: 0.47, 95% CI: 0.24-0.92, P = 0.027). This benefit was primarily observed in patients without atrial fibrillation history (interaction P = 0.005). Arrhythmia- related hospitalization was also significantly reduced (14.1% vs 25.8%, P = 0.048). CONCLUSIONS Empirical CTI ablation is associated with improved freedom from atrial arrhythmia and reduced rehospitalization in CHD patients.
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BibTeX
@article{ditac2026empirical,
title = {{Empirical Cavotricuspid Isthmus Ablation in Congenital Heart Disease: A Nationwide Prospective Study}},
author = {Geoffroy Ditac and Francis Bessière and Guillaume Duthoit and Jean-Luc Pasquié and Laure Champ-Rigot and Mathieu Albertini and Frédéric Anselme and Stefano Bartoletti and Damien Bonnet and Charlène Bredy and Sok-Sithikun Bun and Gaël Clerici and Antoine da Costa and Christian de Chillou and Pascal Defaye and Maxime de Guillebon and Clément Davril and Antoine Delinière and Nicolas Derval and Nabil Dib and Luca Donisi and Kevin Gardey and Caroline Ghanimé and Jean-Baptiste Gourraud and Sébastien Hascoët and Néfissa Hammache and Roland Henaine and Laurence Iserin and Peggy Jacon and François Jourda and Clément Karsenty and Paul Khairy and Linda Koutbi and Gabriel Laurent and Baptiste Maille and Alice Maltret and Jacques Mansourati and Nathan Marimpouy and Raphaël Martins and Philippe Maury and Antoine Milhem and Pamela Moceri and Pierre Ollitrault and Pauline Pinon and Olivier Piot and Karim Benali and Kahina Racelma and Robin Richard-Vitton and Frédéric Sacher and Frédéric Sebag and Marine Tortigue and Sandrine Venier and Marie Wilkin and Pierre-François Winum and Eloi Marijon and Nicolas Combes and Victor Waldmann},
journal = {JACC: Clinical Electrophysiology},
year = {2026},
month = sep,
doi = {10.1016/j.jacep.2026.07.023},
url = {https://hal.science/hal-05739746v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Empirical Cavotricuspid Isthmus Ablation in Congenital Heart Disease: A Nationwide Prospective Study
AU - Geoffroy Ditac
AU - Francis Bessière
AU - Guillaume Duthoit
AU - Jean-Luc Pasquié
AU - Laure Champ-Rigot
AU - Mathieu Albertini
AU - Frédéric Anselme
AU - Stefano Bartoletti
AU - Damien Bonnet
AU - Charlène Bredy
AU - Sok-Sithikun Bun
AU - Gaël Clerici
AU - Antoine da Costa
AU - Christian de Chillou
AU - Pascal Defaye
AU - Maxime de Guillebon
AU - Clément Davril
AU - Antoine Delinière
AU - Nicolas Derval
AU - Nabil Dib
AU - Luca Donisi
AU - Kevin Gardey
AU - Caroline Ghanimé
AU - Jean-Baptiste Gourraud
AU - Sébastien Hascoët
AU - Néfissa Hammache
AU - Roland Henaine
AU - Laurence Iserin
AU - Peggy Jacon
AU - François Jourda
AU - Clément Karsenty
AU - Paul Khairy
AU - Linda Koutbi
AU - Gabriel Laurent
AU - Baptiste Maille
AU - Alice Maltret
AU - Jacques Mansourati
AU - Nathan Marimpouy
AU - Raphaël Martins
AU - Philippe Maury
AU - Antoine Milhem
AU - Pamela Moceri
AU - Pierre Ollitrault
AU - Pauline Pinon
AU - Olivier Piot
AU - Karim Benali
AU - Kahina Racelma
AU - Robin Richard-Vitton
AU - Frédéric Sacher
AU - Frédéric Sebag
AU - Marine Tortigue
AU - Sandrine Venier
AU - Marie Wilkin
AU - Pierre-François Winum
AU - Eloi Marijon
AU - Nicolas Combes
AU - Victor Waldmann
PY - 2026
DA - 2026/09/04
JO - JACC: Clinical Electrophysiology
DO - 10.1016/j.jacep.2026.07.023
UR - https://hal.science/hal-05739746v1
AB - BACKGROUND Recurrence rates of atrial arrhythmias after catheter ablation in patients with congenital heart disease (CHD) remain substantial. Given the high prevalence of peritricuspid flutter, systematic cavotricuspid isthmus (CTI) ablation may represent a rational preventive strategy. OBJECTIVES The objective of this study was to assess the impact of empirical CTI ablation in CHD patients. METHODS This prospective nationwide study included all CHD patients referred for a first catheter ablation of an atrial arrhythmia between 2020 and 2024. Empirical ablation comprised probabilistic (noninducible arrhythmia with prior documentation) and prophylactic (no prior documentation) ablation. The primary endpoint was freedom from any atrial arrhythmia recurrence. Secondary endpoints included arrhythmia-related hospitalizations, redo ablations, and complications. RESULTS Among 575 patients undergoing a first catheter ablation for atrial arrhythmia, 345 (60.0%) had CTI- dependent flutter. The remaining 230 patients formed the study population (mean age: 48.2 ± 16.4 years; 50.9% male). CHD complexity was predominantly moderate (57.4%). Targeted arrhythmias were atrial macro-re-entry (53.0%), atrial fibrillation (47.0%), and focal atrial tachycardia (17.4%), with multiple arrhythmias in 16.5%. Empirical CTI ablation was performed in 71 patients (30.9%) and was associated with significantly higher freedom from any atrial arrhythmia at 1 year (78.1% vs 65.6%, P = 0.010) and 2 years (71.2% vs 56.1%, P = 0.025), remaining independently associated with lower risk of recurrence after multivariable adjustment (HR: 0.47, 95% CI: 0.24-0.92, P = 0.027). This benefit was primarily observed in patients without atrial fibrillation history (interaction P = 0.005). Arrhythmia- related hospitalization was also significantly reduced (14.1% vs 25.8%, P = 0.048). CONCLUSIONS Empirical CTI ablation is associated with improved freedom from atrial arrhythmia and reduced rehospitalization in CHD patients.
SN - 2405-500X
SN - 2405-5018
ER -