Arrhythmias in adult congenital heart disease

摘要

PURPOSE OF REVIEW: Management of arrhythmias is an integral component of care for adults with congenital heart disease (CHD). Our objective was to highlight the important advances from the year 2012 regarding arrhythmias in adult CHD, with a focus on diagnostic considerations, acute management, catheter ablation, and device therapy. RECENT FINDINGS: During the course of 2012, Holter studies suggested that routine screening was helpful in guiding the clinical decisions for certain patient subgroups, such as adults with tetralogy of Fallot. Supportive evidence was provided for the common practice of anticoagulation and/or screening for intracardiac thrombosis by transesophageal echocardiography prior to electrically cardioverting atrial tachyarrhythmias. Advances in catheter ablation, particularly robotic magnetic navigation, offer new hope for patients in whom access to arrhythmia substrates is not feasible by standard means. The subcutaneous defibrillator emerged as an innovative solution of great interest to the patients at risk of sudden death in whom transvenous lead implantation is unachievable or contraindicated. Finally, 2012 ended with a major milestone: the establishment of physician certification in adult CHD by the American Board of Medical Specialties. SUMMARY: The year 2012 witnessed important advances in the diagnosis and management of arrhythmias in adults with CHD.