Ruolo della valutazione elettrofisiologica nella guida all’ablazione intraoperatoria in soggetti con cardiopatia congenita ed indicazione ad intervento di rimodellamento ventricolare destro

Aim:arrhythmias are common in grown up congenital heart disease (CHD) patients (pts).Pts with post surgical pulmonary regurgitation (PR) and right ventricular dilatation,may experience sudden death due to ventricular arrhythmias (VT).Methods:adult pts with PR and RV dilatation requiring cardiac surgery were studied.Baseline EPS was performed. When VT was induced electroanatomical map (EM) of the RV was acquired and, during surgery, RF ablation was performed at sites identified by previous mapping.In all pts, EPS was repeated 6 months after surgery.Results:43 pts were studied.In 9/43 pts VT was reproducibly inducible (5/9 with clinical VT).In these 9 pts and in 1 non inducible pt (clinical VT) EM and ablation was performed.1 pt, with clinical pulseless VT and negative baseline EPS, underwent post-surgical ICD implantation.6 mths follow up data are available for 35/43 pts.VT has been induced in 1/35 pts with negative baseline EPS and in 4/9 pts receiving ablation. In the 1stpt inducibility was suppressed by drug therapy,in 2 pts ICD has been implanted,in 2 pts ICD has been implanted pre-operatively. At a median follow up of 28±13 mths (6-48) no SCD was recorded.Clinical VT was observed in 2 pts, both with post-operative positive EPS and ICD.Conclusions:intraoperative ablation guided by EM appears to be effective in pts with CHD presenting clinical or inducible VTs.Post-operative EPS could be predictive of clinical VT.Pro-arrhythmic role of surgery remains to be estabished.