Management of atrial fibrillation in patients with congenital heart defects

Abstract

Due to improved surgical technologies and post-operative care, long-term survival has improved in patients with congenital heart disease. Atrial fibrillation (AF) is increasingly observed in this aging population and is associated with morbidity and mortality; however, reports about the pathophysiology and the outcome of different treatment modalities of AF are still scarce in patients with congenital heart disease. In this review, the authors describe the epidemiology, pathophysiology and outcome of the different therapies of AF in this specific patient population.

Keywords:

• atrial fibrillation
• cardiac surgery
• congenital heart disease
• mapping
• pharmacological therapy
• pulmonary veins isolation

Financial & competing interests disclosure

NMS de Groot is supported by grants from the Erasmus Medical Center Fellowship, Dutch Heart Foundation, Coolsingel Foundation, Bayer and Boehringer Ingelheim. 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.

Key issues

• The number of patients with congenital heart disease and atrial fibrillation (AF) has increased in the past years and will probably increase even further in the next decades.

• The pathophysiology of AF in patients with congenital heart disease is largely unknown.

• Co-existence of AF and regular atrial tachycardia has been observed in patients with congenital heart disease.

• Pharmacological therapy of AF is limited due to side-effects.

• The ongoing evolvement of sophisticated mapping and ablation techniques will further improve the outcome of ablative therapy of atrial tachyarrhythmia in patients with a complex atrial anatomy.

• The role of the pulmonary veins in the pathophysiology of AF in patients with congenital heart disease is unknown.

• Further research in patients with congenital heart disease and AF is essential to comprehend the pathophysiology of AF and to develop effective therapies.