Position paper concerning the competence, performance and environment required for the practice of ablation in children and in congenital heart disease

Maury P, Thambo JB, Maltret A, Combes N, Hascoet S, Derval N, Ladouceur M, Acar P, Amedro P, Anselm F, Bajolle F, Basquin A, Belli E, Bordachar P, Duthoit G, Di Filippo S, Fauchier L, Gandjbakhch E, Gras D, Gronier C, Karsenty C, Klug D, Koutbi L, Lacotte J, Laurent G, Laux D, Mansourati J, Marijon E, Ovaert C, Sacher F, Sadoul N, Taieb J, Waldmann V, Warinfresse K, Defaye P, Piot O, Boveda S; Working Group of Pacing, Electrophysiology of the French Society of Cardiology, the Affiliate Grou p of Paediatric, Adult Congenital Cardiology of the French Society of Cardiology.Arch Cardiovasc Dis. 2020 May 24:S1875-2136(20)30093-0. doi: 10.1016/j.acvd.2020.02.002. Online ahead of print.PMID: 32461091



The population of patients with congenital heart disease (CHD) is continuously increasing, and a significant proportion of these patients will experience arrhythmias because of the underlying congenital heart defect itself or as a consequence of interventional or surgical treatment. Arrhythmias are a leading cause of mortality, morbidity and impaired quality of life in adults with CHD. Arrhythmias may also occur in children with or without CHD. In light of the unique issues, challenges and considerations involved in managing arrhythmias in this growing, ageing and heterogeneous patient population and in children, it appears both timely and essential to critically appraise and synthesize optimal treatment strategies. The introduction of catheter ablation techniques has greatly improved the treatment of cardiac arrhythmias. However, catheter ablation in adults or children with CHD and in children without CHD is more technically demanding, potentially causing various complications, and thus requires a high level of expertise to maximize success rates and minimize complication rates. As French recommendations regarding required technical competence and equipment are lacking in this situation, the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Affiliate Group of Paediatric and Adult Congenital Cardiology have decided to produce a common position paper compiled from expert opinions from cardiac electrophysiology and paediatric cardiology. The paper details the features of an interventional cardiac electrophysiology centre that are required for ablation procedures in adults with CHD and in children, the importance of being able to diagnose, monitor and manage complications associated with ablations in these patients and the supplemental hospital-based resources required, such as anaesthesia, surgical back-up, intensive care, haemodynamic assistance and imaging. Lastly, the need for quality evaluations and French registries of ablations in these populations is discussed. The purpose of this consensus statement is therefore to define optimal conditions for the delivery of invasive care regarding ablation of arrhythmias in adults with CHD and in children, and to provide expert and – when possible – evidence-based recommendations on best practice for catheter-based ablation procedures in these specific populations.