Supraventricular Arrhythmias in Patients with Adult Congenital Heart Disease

Abstract

Access at: www.AERjournal.comWith the advent of successful surgical repairs and modern diagnostic techniques, an increasing number of patients with congenital heart disease survive to adulthood. Despite these improvements, the surgical corrective atrial incisions performed during childhood lead to subsequent myocardial scarring that have the inherent risk of harbouring substrates for macro-reentrant atrial tachycardias (MRATs). Apart from surgical conduction barriers such as patches, conduits and surgical scars, there are also natural barriers including valve annuli and venous orifices that potentially may become critical substrates for tachyarrhythmias. 1The 20-year risk of developing atrial arrhythmias among patients with adult congenital heart disease (ACHD) was 7 % in a patient aged 20 years and 38 % in a patient aged 50 years in a population-based study. Apart from these tachyarrhythmias, patients with ACHD also have an increased risk of pump failure, stroke and sudden cardiac death (SCD). 6 Although the incidence of SCD is low (0.09 % per year) in the CHD population, it is higher compared with age-matched controls 7 and related to arrhythmias in 14 % of all deaths after initial repair. hearts have the highest risk of SCD (2-9 % per decade). [8][9][10] In the German National Register for Congenital Heart Defects for adult patients, the mortality rate during a median follow-up of 3.7 years was 9.2 % among 2596 patients, with heart failure (27.6 %) and SCD (23.0 %) as the leading causes of death. 11 Deceased patients had a more complex CHD and extracardiac comorbidities.The treatment of CHD imposes certain safety considerations when choosing antiarrhythmic drugs while various cardiac anatomical barriers and required operator expertise should be taken into account when referring patients for catheter ablation. The complex cardiac anatomy and haemodynamic changes require special precautions related to the increased risk of pro-arrhythmia when using antiarrhythmic drugs and the need for specialised expertise and sophisticated mapping systems when complex catheter ablation procedures are performed.Pre-procedural cardiac imaging with a variety of methodologies can assist with venous access to the heart, determining details of native cardiovascular anatomy and the nature of corrective surgery and evaluation of ventricular function. Reviewing all tachycardias from prior ECGs is also important before the procedure. The success rates after catheter ablation in patients with ACHD is somewhat lower compared with the general population, with acute and long-term success rates AbstractAn increasing number of patients with congenital heart disease survive to adulthood; such prolonged survival is related to a rapid evolution of successful surgical repairs and modern diagnostic techniques. Despite these improvements, corrective atrial incisions performed at surgery still lead to subsequent myocardial scarring harbouring a potential substrate for macro-reentrant atrial tachycardia. Macroreentrant atrial tachycardias are the mo...

Feasibility and performance of catheter ablation with zero-fluoroscopy approach for regular supraventricular tachycardia in patients with structural and/or congenital heart disease

“…The differences in clinical parameters might affect the prognosis after an ablative approach and these relationships were described by Sardu et al [25,26] Cardiac arrhythmias are a common occurrence after cardiac surgery because a new arrhythmogenic substrate appears, which is sometimes difficult to identify. [3] Further, deformities of the spine move the heart inside the chest, resulting in an atypical anatomy of the heart in thoracic anomalies and advance scoliosis. This could be a real challenge for electrophysiologists.…”

Therapy of supraventricular and ventricular arrhythmias in adults with congenital heart disease—narrative review

“…Patients with congenital heart disease can also develop paroxysmal SVT due to atrioventricular nodal reentrant tachycardia (AVNRT) or atrioventricular tachycardia (AVRT) via an accessory pathway and focal atrial tachycardia (13). Accessory pathways and associated arrhythmias are most often seen in Ebstein's anomaly and congenitally corrected transposition of the great arteries (14)(15)(16)(17)(18). Twin AV-nodes are present most often in patients with congenitally corrected TGA (1,19,20) and can give rise to AVNRT in these patients.…”

Noteworthy Literature published in 2017 for Congenital Cardiac Anesthesiologists

“…Two articles in 2017 nicely review arrhythmias in adults with CHD. 89,90 The important message throughout all of these arrhythmia articles is that atrial arrhythmias are not a bystander in the natural history of adult CHD, but deserve careful diagnosis, monitoring, and management. Arrhythmias are a frequent cause of sudden cardiac death (SCD) in adults with CHD.…”