Extrasystoles in adults with congenital heart disease: treatment options

The prevalence of congenital heart disease (CHD) is estimated to be almost one in 100 newborns, with > 90% of patients with CHD surviving into adulthood due to medical and surgical advances in recent decades. The rationale for treatment of ventricular premature beats (VPBs) in the general population without underlying structural heart disease is mainly based on the presence of symptoms and/or the risk for developing VPB-induced cardiomyopathy in patients with very frequent VPBs. In CHD, the same general principles apply, but the clinical picture is often more complicated due to the presence of symptoms and/or systolic dysfunction resulting from the underlying heart disease itself. Sudden cardiac death due to ventricular arrhythmias is a major concern in the CHD population, although its incidence is relatively low (<0.1%/year). Beta-blockers are the first-line medical treatment for CHD patients with VPBs, although no dedicated studies are available on the use of beta-blockers or anti-arrhythmic drugs in patients with CHD for this indication. Catheter ablation has evolved in recent years as an important treatment modality for cardiac arrhythmias, generally showing superior efficacy over medical treatment for most types of arrhythmias. However, recent technological advances have led to improved methods for ablation even in complex underlying anatomical substrates, with possibilities for image fusion between three-dimensional imaging modalities and electroanatomical mapping systems during the procedure. In addition to a discussion of the above, the article also presents two examples of VPB ablation in CHD patients.