Atrial Tachyarrhythmia in Congenital Heart Disease: Beyond the Suture Lines.

Abstract

See Article by Avila et al Atrial tachyarrhythmias, including atrial fibrillation (AF) and regular atrial tachycardia (AT), are important complications after cardiac surgery for congenital heart disease (CHD) that lead to increased morbidity and mortality.1 As the adult population of CHD patients is steadily increasing as a result of improved healthcare and surgical techniques, the prevalence of AF and AT among these patients also continues to rise. To date, prevalence rates of atrial tachyarrhythmias in patients with CHD are 3 times higher than in the general population.2 In addition, ventricular tachycardia and ventricular fibrillation, though less prevalent, still contribute to sudden death and reduce long-term survival rates in patients with CHD.3 In adult patients with CHD, the majority of atrial tachyarrhythmias are intra-atrial reentrant tachycardia or AF although the incidence differs between the various types of CHD. Patients with a univentricular heart (UVH) who underwent a Fontan procedure undoubtedly have the highest risk for atrial tachyarrhythmia; 50% of patients will develop AT or AF within 10 years increasing to 100% after 26 years.4,5 Other CHD patients at high risk for atrial arrhythmia include those with transposition of the great arteries (TGA) or tetralogy of Fallot. TGA patients who have had an atrial switch procedure have a risk of 30% to develop atrial tachyarrhythmias within 10 years after Mustard or Senning repair, which rises up to 40% within 35years after surgery.6,7 In tetralogy of Fallot patients, up to 20% will develop intra-atrial reentrant tachycardia …