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Background  Intra‐atrial re‐entrant tachycardia ( IART ) in patients with congenital heart disease ( CHD ) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first‐line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed  IART  radiofrequency catheter ablation in  CHD .    Methods and Results  The observational study included all consecutive patients with  CHD  who underwent a first ablation procedure for  IART  at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114  IART  were ablated (acute success: 74.6%; 1.21±0.41  IART  per patient) with an acute success of 74.5%. Cavotricuspid isthmus–related  IART  was the only arrhythmia in 51%; non–cavotricuspid isthmus–related  IART  was the only mechanism in 27.7% and 21.3% of the patients had both types of  IART . Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus  IART  (odds ratio 7.3; confidence interval [CI], 1.9–17.9;  P =0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3–18.4;  P =0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4–17.2;  P =0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1–21.7;  P =0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74–0.93,  P =0.001). After a mean follow‐up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure).    Conclusions  Although ablation in  CHD  is a challenging procedure, acute success of 75% can be achieved in moderate–highly complex  CHD  patients in a referral center. Predictors of failed ablation are  IART  different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex  CHD  (transposition of great arteries, systemic ventricle dilation).

journal of the american heart association

Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation