Advances in surgery and clinical care have resulted in a progressive increase in life expectancy of patients with congenital heart disease (CHD). Cardiac arrhythmias are a common and onerous complication in CHD, of which atrial fibrillation (AF) is rapidly increasing in prevalence. AF frequents coexists with intra-atrial reentrant tachycardias. AF onset and prevalence may vary as a function of the congenital lesion as well as the operative repair. AF progression to a persistent or permanent form may be rapid. Cardioembolic risks in this population are higher compared to those without CHD. Common cardioembolic risk predictors lack validation in this population. Rhythm control with antiarrhythmic drugs can be challenging due to low efficacy and toxicity. Rate control is critical as AF with rapid ventricular rates may be poorly tolerated in patients with complex CHD and may be associated with an increased risk of sudden cardiac death. There is limited evidence for the role of percutaneous catheter ablation for AF. Concurrent atrial arrhythmia surgery should be considered in patients with a prior history of AF scheduled to undergo open cardiac surgery primarily to address an underlying cardiac lesion. Much further work is needed to expand our understanding of the mechanism of AF in CHD and improve efficacy of catheter ablation in this population.
Catheter ablation of intra-atrial re-entrant tachycardia in adult congenital heart disease: Value of final programmed atrial stimulation
