Tachyarrhythmias and catheter ablation in adult congenital heart disease

Abstract

Advances in surgical technique have had an immense impact on longevity and quality of life in patients with congenital heart disease. However, an inevitable consequence of these surgical successes is the creation of a unique patient population whose anatomy, surgical history and haemodynamics result in the development of a challenging and complex arrhythmia substrate. Furthermore, this patient group remains susceptible to the arrhythmias seen in the general adult population. It is through a thorough appreciation of the cardiac structural defect, the surgical corrective approach, and haemodynamic impact that the most effective arrhythmia care can be delivered. Catheter ablation techniques offer a highly effective management option but require a meticulous attention to the real-time integration of anatomical and electrophysiological information to identify and eliminate the culprit arrhythmia substrate. This review describes the current approach to the interventional management of patients with tachyarrhythmias in the context of congenital heart disease.

Keywords::

• arrhythmia
• congenital heart disease
• electrophysiology
• sudden death

Acknowledgements

The authors acknowledge the support and expertise of the congenital cardiac teams at St Thomas’ Hospital, London and Evelina London Children’s Hospital, London, UK.

Financial & competing interests disclosure

The authors received financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Arrhythmias in congenital heart disease are a major cause of morbidity and mortality.

• The development of arrhythmias results from a complex interplay of congenital and acquired factors, but recognized patterns are increasingly well-described.

• The evolution of surgical techniques has radically altered the observed spectrum of arrhythmias in adult congenital heart disease.

• Catheter interventions for arrhythmias are increasingly successful with improved physiological understanding and equipment advances.

• Novel techniques for access may often be required.

• A thorough understanding of a patient’s anatomy and interventional history is important.

• Electroanatomical mapping methods play a key role in many complex congenital ablations, and may be complemented by cross-sectional imaging.

Notes