Benefits and Potential Risks of Atrial Antitachycardia Pacing After Repair of Congenital Heart Disease

Abstract

Atrial reentry tachycardia is common after surgical repair of congenital heart disease. The arrhythmia is often difficult to treat and is occasionally life-threatening. This study reports experience with atrial antitachycardia (AAIT mode) pacing for the management of atrial reentry tachycardia, with emphasis on the risks and benefits of automatic pacing therapy. Eighteen patients (2-32 years of age) with a variety of congenital heart lesions underwent atrial antitachycardia pacemaker placement for recurrent atrial tachycardia that was amenable to pace termination prior to the implantation procedure. An appropriate antitachycardia program was determined by repeated induction and termination of atrial tachycardia using the noninvasive programmed stimulation mode of the pacemaker. Over 4-30 months of follow-up, 6 patients had 189 episodes of tachycardia successfully converted with AAI-T pacing, 4 patients had 8 episodes of tachycardia detected but not successfully converted, and 8 patients had no episodes of tachycardia with antibradycardia pacing alone. The number of patients receiving pharmacological therapy other than digoxin or beta blockade fell from 12 to 6. Two subjects died suddenly, 1 while wearing a Holter monitor. In both, tachycardia was detected and pace cardioversion attempted. Atrial antitachycardia pacing is a useful tool in the management of patients with congenital heart disease and atrial arrhythmias; however, in selected cases, it may not prevent and may even exacerbate the lethal complications of the tachycardia. Antitachycardia function evaluation is recommended under varying levels of autonomic stress prior to institution of automatic therapy.