Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.

Young patients may experience LTE from WPW syndrome without prior symptoms or markers of high-risk on EPS.

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ABSTRACT. Voltage mapping has been used previously for slow-pathway localization for atrioventricular nodal reentrant tachycardia (AVNRT) ablation. However, propagation mapping may be a technique to further improve the localization of the slow pathway. This retrospective study aimed to evaluate the relationship of the propagation map to both the voltage mapping and successful site of ablation in patients who underwent ablation for AVNRT. All patients r20 years of age who underwent voltage mapping for AVNRT were included in this study. Patients were excluded if they had congenital heart disease or inadequate voltage point density within the triangle of Koch (TK). During the study, a propagation map was evaluated from the prior voltage map, marking a ''wave collision'' at the site of atrial wave convergence. Patient and procedural information, the location of the wave collision, the site of successful ablation, and the appearance of the voltage map were evaluated. Ultimately, 39 patients aged from four years of age to 20 years of age were evaluated. Success was achieved in 100% of patients, with a recurrence rate of 2.8% and no long-term complications observed. The average procedure time was 127 min. Follow-up length averaged seven months post operation. Low-voltage areas, and a wave collision, were present in all patients. This wave collision was typically located within the TK. The median number of ablations required for successful outcome was two. The successful ablation lesion was typically located over a low-voltage area within 4 mm of the wave collision within the TK. In conclusion, we found in this retrospective evaluation that propagation mapping resulted in a wave collision within the TK, and that the successful ablation site in the majority of patients was near a low-voltage area within 4 mm, typically superiorly, to the wave collision within the TK.

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This study suggests a less-invasive posttransplant approach that avoids biopsies and steroids was safely implemented in this single center. Both groups had similar survival. However, group 2 had statistically significant less posttransplant rejection, hypertension, and diabetes. Overall, this study shows no increased risk associated with steroid and biopsy avoidance in posttransplant patients, but with some clear benefits.

Combining cath and EP outpatient procedures reduces the time commitment and provides some economic advantage.

Up to 10% of Fontan patients require pacemakers; an epicardial approach has historically been used. A transvenous approach can be used but carries risk of Fontan obstruction, thromboembolism, and can be technically challenging. The safety and efficacy of these approaches is not well described. The aim of this study was to compare epicardial and transvenous pacemaker outcomes in Fontan patients, specifically, device performance and adverse event rate. A retrospective review was performed on Fontan pacemaker patients followed at a single institution. Thirty-one Fontan pacemaker patients were identified between 1985 and 2017. Twenty-six had an epicardial system, five transvenous, and three converted from epicardial to transvenous. Average atrial lead sensing at placement was 3.23 versus 2.35 mV (p = 0.52) for epicardial and transvenous leads, respectively. Median atrial and ventricular lead longevity was 86.4 versus 98.8 months (p = 0.56) and 73.2 versus 140 months (p = 0.3) with generator longevity of 65.5 versus 73.9 (p = 0.16) months for epicardial versus transvenous systems, respectively. One major complication occurred in a transvenous patient, and two minor complications occurred in epicardial patients. All transvenous patients received warfarin except one, who converted to dabigatran. Epicardial patients received aspirin (n = 20), warfarin (n = 3) or a warfarin/aspirin combination (n = 3). No thromboembolic events occurred. System revision was required in 13 epicardial and 5 transvenous patients. There were two deaths, none related to the pacemaker system. Transvenous pacemakers can be utilized with equal efficacy compared to epicardial pacemakers with trends toward longer lead longevity in transvenous pacemaker systems.