Arrhythmia diagnosis and management throughout life in congenital heart disease

Area of Science:

• Cardiology
• Electrophysiology
• Pediatric Cardiology

Background:

• Arrhythmias, including bradycardia and tachycardia, are frequently observed in patients with congenital heart disease (CHD).
• These rhythm disturbances can arise from unrepaired CHD or as a complication of surgical interventions affecting the cardiac conduction system.
• Scar formation, chamber dilation, and increased pressure post-surgery create substrates for re-entrant tachyarrhythmias.

Purpose of the Study:

• To review the occurrence and management of arrhythmias in patients with congenital heart disease.
• To highlight the mechanisms underlying bradycardia and tachycardia in this population.
• To discuss current therapeutic strategies, including device implantation and ablation.

Main Methods:

• Literature review of arrhythmias in congenital heart disease.
• Analysis of electrophysiological mechanisms (sinus node dysfunction, AV block, re-entry).
• Evaluation of treatment modalities such as defibrillator implantation and 3D electroanatomic mapping-guided ablation.

Main Results:

• Symptomatic bradycardia is linked to sinus node dysfunction or atrioventricular block.
• Tachyarrhythmias, particularly atrial arrhythmias, are common post-repair.
• Ventricular tachyarrhythmias in specific conditions (e.g., repaired tetralogy of Fallot) increase sudden cardiac death risk.
• Defibrillators and ablation offer effective treatment for hemodynamically significant arrhythmias.

Conclusions:

• Electrophysiological advances have significantly improved arrhythmia management in congenital heart disease patients.
• Both pharmacologic and device-based therapies, alongside ablation, are crucial for patient care.
• Continued research is needed to further refine treatment strategies and reduce adverse outcomes.