Natural History and Clinical Predictors of Atrial Tachycardia in Adults With Congenital Heart Disease

Ávila, Pablo; Oliver, José M.; Gallego, Pastora; González–García, Ana; Rodríguez-Puras, María J.; Cambronero, E.; Ruiz‐Cantador, Jose; Campos, A. García; Peinado, Rafaél; Prieto, Raquel; Sarnago, Fernando; Yotti, Raquel; Fernández-Avilés, Francisco

doi:10.1161/circep.117.005396

Cited by 37 publications

(31 citation statements)

References 39 publications

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“…Avila et al 45 sought to identify factors associated with the development of atrial tachycardia in adults with CHD. In a cohort of 3311 patients presenting with atrial tachycardia, they identified 8 factors independently associated with atrial tachycardia, including univentricular physiology, previous intracardiac repair, systemic right ventricle, pulmonary hypertension, pulmonary regurgitation, pulmonary atrioventricular valve regurgitation, and pulmonary and systemic ventricular dysfunction.…”

Section: Pediatric and Congenital Heart Disease Atrial Arrhythmiasmentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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1 In the past year, there have been key advances in our understanding of arrhythmia mechanisms and diagnosis and important new therapies. We have seen advances in basic cardiac electrophysiology with demonstration of optogenetic targeting of atrial fibrillation (AF) rotors, induced pluripotent stem cell-based biological pacemakers, small-conductance Ca 2+ -activated K + (SK) channels as targets for AF treatment, and reductions in inward rectifier potassium current in promoting ventricular fibrillation. Hand-held ECG devices and implantable loop recorders have been shown to detect subclinical AF. Catheter ablation of AF in patients with left ventricular dysfunction improves outcomes compared with medical therapy. Both hybrid thoracoscopic surgical and catheter ablation procedures and off-pump surgery for AF have demonstrated efficacy. Anticoagulation with uninterrupted dabigatran had a lower major bleeding rate compared with uninterrupted warfarin after AF ablation. Studies have examined optimizing access to automatic external defibrillators by identifying optimal locations for placement and possibility of using a drone delivery network. In long-QT syndrome, there are advances in understanding of ECG predictors of arrhythmic events, the role of the role of gene variants in conferring arrhythmic risk, and effect of age and sex on QTc interval. There are numerous advances in the treatment of ventricular tachycardia, including noninvasive cardiac radiation. Catheter ablation and implantable devices continue to demonstrate effectiveness in patients with congenital heart disease.In the past year, there have been numerous ground-breaking discoveries and observations that illustrate the vibrancy and promise of our field. In this review, we have tried to capture articles published in the year 2017 of particular interest to cardiac electrophysiologists. Although we have focused on articles from our journal, we have captured many of the most impactful articles in numerous other journals. We apologize for omitting a large number of other important articles that cannot be included in this review because of space limitations. We have placed some of these in our Data Supplement. BASIC ELECTROPHYSIOLOGY BradyarrhythmiasThe search for new biological therapies for bradycardia met with recent progress as human keratinocytes genetically reprogrammed into electrically unstable cardiomyocytes were shown to persist and provide continued catecholaminergic-responsive pacing for 13 weeks after subepicardial injection into immunosuppressed dogs at the time of atrioventricular (AV) node ablation.1 Although only 40% to 80% of the beats matched the site of cell injection, this is first study to test a human induced pluripotent stem cell-based biological pacemaker in a large animal model of heart block and represents an important step forward in biological pacing.

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Section: Pediatric and Congenital Heart Disease Atrial Arrhythmiasmentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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“…Cumulative freedom from SND was estimated using a right-censored Kaplan-Meier curve, constructed with age as time scale. 3 A P value < 0.05 was considered statistically significant. Statistical analysis was performed with SPSS version 24 (IBM Corporation, Armonk, New York).…”

Section: Discussionmentioning

confidence: 99%

“…This may explain the relatively low incidence of dysrhythmias, which may be expected to increase with increasing age, as seen with other CHD types. 3,4 However, in our opinion, this time period represents stable surgical experienceabout 10 years after introduction of the 2-patch technique 2 -and encompasses patients currently entering (early) adulthood, who may be at risk of development of dysrhythmias.…”

Section: Study Limitationsmentioning

confidence: 99%

“…Previous studies have shown that the incidence of dysrhythmias in patients with congenital heart disease (CHD) steadily increases with increasing age. 3,4 In patients with an atrial septal defect (ASD), age at repair-and thus duration of volume overload and subsequent arrhythmogenic atrial stretch 5 -is associated with development of atrial tachyarrhythmias (AT). [5][6][7] The reported incidence of AT was lower when ASD repair was performed at a younger age.…”

Section: Introductionmentioning

confidence: 99%

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Dysrhythmias in patients with a complete atrioventricular septal defect: From surgery to early adulthood

Houck

Evertz

Teuwen

et al. 2018

Congenital Heart Disease

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Objective: Outcomes after surgical repair of complete atrioventricular septal defect (cAVSD) have improved. With advancing age, the risk of development of dysrhythmias may increase. The aims of this study were to (1) examine development of sinus node dysfunction (SND), atrial and ventricular tachyarrhythmias, and (2) study progression of atrioventricular conduction abnormalities in young adult patients with repaired cAVSD. Study design:In this retrospective multicenter study, 74 patients (68% female) with a cAVSD repaired in childhood were included. Patients' medical files were evaluated for occurrence of SND, atrioventricular conduction block (AVB), atrial and ventricular tachyarrhythmias.Results: Median age at repair was 6 months (interquartile range 3-10) and median age at last follow-up was 24 years (interquartile range 21-28). SND occurred after a median of 17 years (interquartile range 11-19) after repair in 23% of patients, requiring pacemaker implantation in two patients (12%). Regular supraventricular tachycardia was observed in three patients (4%). Atrial fibrillation and ventricular tachyarrhythmias were not observed. Twenty-seven patients (36%) had first-degree AVB, which was self-limiting in 16 (59%) and persistent in 10 (37%) patients. One patient developed third-degree AVB 7 days after left atrioventricular valve replacement.Spontaneous type II second-degree AVB occurred in a 28-year-old patient. Both patients underwent pacemaker implantation.Conclusions: Clinically significant dysrhythmias were uncommon in young adult patients after cAVSD repair. However, three patients required pacemaker implantation for either progression of SND or spontaneous type II second-degree AVB. Longer follow-up should point out whether dysrhythmias will progress or become more prevalent with increasing age. K E Y W O R D Sadult congenital heart disease, atrial tachyarrhythmias, atrioventricular conduction block, complete atrioventricular septal defect, sinus node dysfunction This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…Arrhythmias are frequently encountered in patients with congenital heart disease (CHD; with or without corrective surgery) and respond poorly to pharmacologic therapies. [98][99][100] Catheter ablation is a valuable treatment option but must respond to many challenges with regard to the anatomical variances, type of arrhythmia substrate, and access to the target chamber. 88,[101][102][103][104] In all these patients, a careful review of the entire hemodynamic and arrhythmia situation needs to be performed prior to the procedure and, if available, operation notes need to be reviewed.…”

Section: Chap Ter 6: Us E Of 3d Mapping In Arrhy Thmia S In Cong Enmentioning

confidence: 99%

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

Kim

Chen

Ernst

et al. 2020

Journal of Arrhythmia

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Natural History and Clinical Predictors of Atrial Tachycardia in Adults With Congenital Heart Disease

Cited by 37 publications

References 39 publications

Year in Review in Cardiac Electrophysiology

Year in Review in Cardiac Electrophysiology

Dysrhythmias in patients with a complete atrioventricular septal defect: From surgery to early adulthood

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

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