Anticoagulation in adults with congenital heart disease: The who, the when and the how?

Jensen, Annette Schophuus; Idorn, Lars; Nørager, Betina; Vejlstrup, Niels; Søndergaard, Lars

doi:10.1136/heartjnl-2014-305576

Cited by 43 publications

(39 citation statements)

References 32 publications

(43 reference statements)

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“…Ponadto leczenie przeciwzakrzepowe u dorosłych pacjentów z wrodzoną wadą serca, u których występują tachyarytmie przedsionkowe, należy rozważać w przypadku przebytej wewnątrzsercowej operacji naprawczej, występowania sinicy, stanu po leczeniu paliatywnym z wytworzeniem krążenia typu Fontana, a także systemowej prawej komory [968]. Można stosować beta--adrenolityki, werapamil, diltiazem oraz naparstnicę.…”

Section: Ogólne Zasady Leczenia Tachyarytmii Przedsionkowych U Dorosłunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,379

4,206

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Section: Ogólne Zasady Leczenia Tachyarytmii Przedsionkowych U Dorosłunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,379

4,206

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“…Of note, this and the HAS-BLED score have not been evaluated in patients with ACHD. Their applicability and potential benefit in these patients is uncertain, but at this time there is no better instrument for risk stratification available and its application is therefore recommended in current guidelines 23. Recently, a study evaluated thrombotic and bleeding events in 229 patients with ACHD 24.…”

Section: Acute Treatment Of Svt In Achdmentioning

confidence: 99%

Management of supraventricular arrhythmias in adults with congenital heart disease

Wasmer

Eckardt

2016

Heart

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Supraventricular arrhythmias are a frequent complication in adults with congenital heart disease (ACHD). The prevalence increases with time since surgery, complexity of the underlying defect, type of repair and older age at surgery. Arrhythmias are the most frequent reason for hospital admission and along with heart failure the leading cause of death. The arrhythmia-associated increase in morbidity and mortality makes their management a key task in patients with ACHD. Intra-atrial re-entry is the most frequent arrhythmia mechanism. Less common arrhythmia mechanisms are supraventricular tachycardias in the presence of an accessory pathway, atrioventricular nodal re-entrant tachycardia or focal tachycardias. Patient management includes stroke prevention, acute termination and prevention of arrhythmia recurrence. Acute treatment depends on patients' symptoms. In cases of haemodynamic instability, immediate cardioversion is warranted. For stable patients, acute treatment includes rate control and termination by antiarrhythmic drugs or electrical cardioversion. Following a symptomatic arrhythmia, catheter ablation or treatment with antiarrhythmic drugs is recommended to prevent recurrences. Advances in mapping and ablation technology are now associated with high success rates of catheter ablation. In patients with a complex substrate recurrence rates of 50% remain high. However, in the presence of side effects and complications associated with long-term antiarrhythmic drug therapy, redo procedures are encouraged by current guidelines.

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“…The authors evaluated dichotomized CHA2-DS2-VASc and HAS-BLED scores in their ACHD cohort and reported that thrombotic and bleeding events can be predicted by using scoring systems[97]. In moderate/complex patients with IART or AF, long-term oral anticoagulation is recommended with vitamin K antagonist (VKA) however, in simple nonvalvular CHD, the decision of anticoagulation risk can be guided by CHA2DS2-VASc score[17,98]. Patients with CHA2DS2-VASc score of ≥ 2 need oral anticoagulation with VKA or novel oral anticoagulants[17].…”

Section: Management Of Chronic or Recurrent Atrial Arrhythmias In Achmentioning

confidence: 99%

Atrial tachyarrhythmia in adult congenital heart disease

Karbassi¹,

Nair²,

Harris³

et al. 2017

WJC

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The adult congenital heart disease (ACHD) population continues to grow and most cardiologists, emergency room physicians and family doctors will intermittently come into contact with these patients. Oftentimes this may be in the setting of a presentation with atrial tachyarrhythmia; one of the commonest late complications of ACHD and problem with potentially serious implications. Providing appropriate initial care and ongoing management of atrial tachyarrhythmia in ACHD patients requires a degree of specialist knowledge and an awareness of certain key issues. In ACHD, atrial tachyarrhythmia is usually related to the abnormal anatomy of the underlying heart defect and often occurs as a result of surgical scar or a consequence of residual hemodynamic or electrical disturbances. Arrhythmias significantly increase mortality and morbidity in ACHD and are the most frequent reason for ACHD hospitalization. Intra-atrial reentrant tachycardia and atrial fibrillation are the most prevalent type of arrhythmia in this patient group. In hemodynamically unstable patients, urgent cardioversion is required. Acute management of the stable patient includes anticoagulation, rate control, and electrical or pharmacological cardioversion. In ACHD, rhythm control is the preferred management strategy and can often be achieved. However, in the long-term, medication side-effects can prove problematic. Electrophysiology studies and catheter ablation are important treatments modalities and in certain cases, surgical or percutaneous treatment of the underlying cardiac defect has a role. ACHD patients, especially those with complex CHD, are at increased risk of thromboembolic events and anticoagulation is usually required. Female ACHD patients of child bearing age may wish to pursue pregnancies. The risk of atrial arrhythmias is increased during pregnancy and management of atrial tachyarrhythmia during pregnancy needs specific consideration.

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Anticoagulation in adults with congenital heart disease: The who, the when and the how?

Cited by 43 publications

References 32 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Management of supraventricular arrhythmias in adults with congenital heart disease

Atrial tachyarrhythmia in adult congenital heart disease

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