Feasibility and outcome of supraventricular tachycardia ablation via a retrograde access using remote magnetic navigation in patients with physiologically univentricular hearts after Damus-Kaye-Stansel surgery

Abstract Aims Supraventricular tachycardia (SVT) is one of the most frequent complications in adult patients with congenital heart disease (CHD). Limited experience exists for successful ablation in complex CHD patients with prior Damus-Kaye-Stansel (DKS) surgery. Methods All patient files of a single-center were screened retrospectively to identify CHD patients with prior DKS surgery throughout a time-interval from 1998 to 2020. These were analysed with focus on SVT, treatment and outcome of catheter ablation (CA). Results Overall, 13 patients with prior DKS surgery were identified (median age 22.0 years (IQR 20.5–25.5 years), 76.9% male, 92.3% NYHA Class I, median systemic ventricular ejection fraction 58.5% (IQR 53.0–65.5), 69.2% extra cardiac tunnel). Seven patients (53.8%) presented with symptomatic SVT (median cycle length 440 ms (IQR 360–517 ms)). Of these, five patients underwent CA using remote magnetic navigation. The majority of procedures were performed through a retrograde access using three-dimensional image integration. Median procedure time was 180.5 min (IQR 160.8–274.5 min), median fluoroscopy time 1.5 min (IQR 0.5–4.7 min) and radiofrequency time 851 s (265–2005 s). No peri- or postinterventional complications were observed. After a mean of 1.5 procedures, all patients were complaint-free without documentation of tachycardia recurrence throughout a median follow-up of 13 months (IQR 5.8–17.5 months). Conclusion In complex univentricular situations after Damus-Kaye-Stansel surgery, ablation for supraventricular tachycardia can be achieved safely and successfully. Techniques such as remote magnetic navigation and three-dimensional image integration may aid for successful procedure results.