Limited data exist on the impact of gender and specialized care on the requirement of repeat treatment of supraventricular tachycardia (SVT) in adult patients with congenital heart disease (ACHD).

The study aimed to assess independent predictors for a combined endpoint of re-CA or cardioversion at 3 years of follow-up including the impact of gender and specialized ACHD care.

All ACHD registered at a database of one of the largest German Health Insurers (≈9.2 million members) who underwent catheter ablation (CA) for SVT were analyzed.

Of 38,892 ACHD ≥16 years, 485 (49.5% women, median age 58.4 years) underwent CA for SVT. Over the three-year follow-up, the number of yearly CA increased significantly particularly for treatment of atrial fibrillation (AF) (+195%) and atrial flutter (+108%). Moderate to severe complexity heart disease (Odds ratio [OR] 1.66; p=0.01), advanced age (OR 1.85 per year; p=0.02), chronic kidney disease (OR 1.70; p=0.01) and AF (OR 2.02; p=0.002) emerged as independent predictors for re-treatment. Re-treatment was significantly less often performed if the primary CA was carried out at a specialized ACHD center (p=0.009) in patients with moderate to severe complexity. Women treated at specialist centers had a 1.6-fold reduced risk of undergoing re-treatment (p=0.01).

CA for SVT is increasingly performed in ACHD, especially for atrial flutter and atrial fibrillation. Patients with moderate and severe complexity congenital heart defects and female ACHD benefit from upfront referral to specialized ACHD centers for CA. Centralization of care for ACHD arrhythmias should thus be advocated.