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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2017; 9(6): 496-507
Published online Jun 26, 2017. doi: 10.4330/wjc.v9.i6.496
Atrial tachyarrhythmia in adult congenital heart disease
Arsha Karbassi, Krishnakumar Nair, Louise Harris, Rachel M Wald, S Lucy Roche
Arsha Karbassi, Krishnakumar Nair, Louise Harris, Rachel M Wald, S Lucy Roche, Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, University Health Network, Toronto, ON M5G 2N2, Canada
S Lucy Roche, Division of Cardiology, 5N-521 Toronto General Hospital, Toronto, ON M5G 2N2, Canada
Author contributions: Karbassi A contributed to literature review and first draft of the manuscript; Nair K revised the section related to electrophysiology study and ablation; Harris L reviewed the completed manuscript and provided content edits; Wald RM edited the section on arrhythmia in pregnancy; Roche SL conceived the idea, structured, revised and edited each version of the manuscript.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. S Lucy Roche, Staff Cardiologist, Division of Cardiology, 5N-521 Toronto General Hospital, 585 University Avenue, Toronto, ON M5G 2N2, Canada. lucy.roche@uhn.ca
Telephone: +1-416-3403266 Fax: +1-415-3405014
Received: January 15, 2017
Peer-review started: January 16, 2017
First decision: March 8, 2017
Revised: March 22, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: June 26, 2017
Processing time: 161 Days and 2 Hours
Abstract

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.

Keywords: Congenital heart disease; Arrhythmia; Adult; Ablation

Core tip: This review highlights the importance of atrial tachyarrhythmia in adult congenital heart disease (ACHD) patients. It discusses causative mechanisms of arrhythmia, treatment of arrhythmia in the acute setting and on a long-term basis, including: Medications, catheter ablation, and anticoagulation. We include specific comments on the treatment of arrhythmias in ACHD patients who are pregnant.