Arrhythmic burdens in patients with tetralogy of Fallot: A national database study

Wu, Mei‐Hwan; Lu, Chun‐Wei; Chen, Hui‐Chi; Chiu, Shuenn–Nan; Kao, Feng-Yu; Huang, San‐Kuei

doi:10.1016/j.hrthm.2014.11.026

Cited by 53 publications

(27 citation statements)

References 21 publications

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“…Because of the residual hemodynamic and electrophysiological disturbances, tachyarrhythmia in repaired TOF is common 12, 13, 14. According to data from the Alliance for Adult Research in Congenital Cardiology, tachyarrhythmia occurred in 29.9% of adult TOF patients and in a higher percentage of older patients.…”

Section: Discussionmentioning

confidence: 99%

Adult Congenital Heart Disease in a Nationwide Population 2000–2014: Epidemiological Trends, Arrhythmia, and Standardized Mortality Ratio

Chen

et al. 2018

JAHA

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BackgroundThe adult congenital heart disease (ACHD) population will grow with medical advances, but data are limited. We investigated the epidemiological profile of ACHD in Taiwan, a country with a congenital heart disease program since 1955, population of 23 million, and easily accessible high‐standard medical care.Methods and Results ACHD patients, born after 1954, were identified from the nationwide database 2000–2014. The ACHD prevalence in the population aged 18 to 59 was 140.53, 157.08, 182.45, and 217.00 per 100 000 in 2000, 2005, 2010, and 2014, respectively (increasing time trend, P<0.0001). Percentage of severe ACHD also increased over time (P<0.0001) and was 11.70% in 2014. The 5 leading ACHD diagnoses were ventricular septal defect, secundum atrial septal defect, patent ductus arteriosus, pulmonary stenosis, and tetralogy of Fallot. Freedom from tachyarrhythmia at age 50 years was 0.574 and 0.710 for severe and simple ACHD, respectively. Cardiac causes accounted for the majority of deaths, followed by malignancy in simple ACHD and external causes/sudden death/out‐of‐hospital death in severe ACHD patients. The proportion of unexpected death was 10%. Compared with the general population, the standardized mortality ratio was higher not only in severe ACHD (3.164; 95% confidence interval, 2.664–3.664), but also in women with simple ACHD (1.704; 95% confidence interval, 1.499–1.909), with a higher proportion of cardiac, labor, and sudden death as causes of death.ConclusionsWe demonstrated an increasing trend in ACHD prevalence and medical complexity. They are at risk of tachyarrhythmia, higher mortality, and unexpected deaths, suggesting a gap in their medical care.

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Section: Discussionmentioning

confidence: 99%

Adult Congenital Heart Disease in a Nationwide Population 2000–2014: Epidemiological Trends, Arrhythmia, and Standardized Mortality Ratio

Chen

et al. 2018

JAHA

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“…In patients with atrial septal defect (ASD) repair prior to age 15, SVT was observed in 16% during mean follow-up of 35 years,7 while patients with uncorrected ASD or surgery as adult experience SVT in up to 50% 8. Patients with repair of tetralogy of Fallot also have an age-dependent risk of up to 20% to develop IART 9 10. Due to extensive scarring, patients with transposition of the great arteries (TGA) and atrial switch surgery have a high incidence of atrial arrhythmias 11.…”

Section: Pathophysiology 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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“…84 The occurrence of SVTs was recently reported to be associated with higher mortality rates (15.6 % versus 8.6 %; p=0.001). 85 In the majority of patients, a right BBB is present during sinus rhythm, which may cause differential diagnostic difficulties requiring electrophysiology testing. 86 MRAT can be a sign of worsening ventricular function and a haemodynamic evaluation of the repair is therefore warranted.…”

Section: Tetralogy Of Fallotmentioning

confidence: 99%

Supraventricular Arrhythmias in Patients with Adult Congenital Heart Disease

Lundqvist

Potpara

Malmborg

2017

Arrhythmia &Amp; Electrophysiology Review

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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...

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Arrhythmic burdens in patients with tetralogy of Fallot: A national database study

Cited by 53 publications

References 21 publications

Adult Congenital Heart Disease in a Nationwide Population 2000–2014: Epidemiological Trends, Arrhythmia, and Standardized Mortality Ratio

Adult Congenital Heart Disease in a Nationwide Population 2000–2014: Epidemiological Trends, Arrhythmia, and Standardized Mortality Ratio

Management of supraventricular arrhythmias in adults with congenital heart disease

Supraventricular Arrhythmias in Patients with Adult Congenital Heart Disease

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