Technological Advances in Arrhythmia Management Applied to Adults With Congenital Heart Disease

Updates in Arrhythmia Management in Adult Congenital Heart Disease

Arrhythmias are highly prevalent in adults with congenital heart disease. For the clinician caring for this population, an understanding of pathophysiology, diagnosis, and management of arrhythmia is essential. Herein we review the latest updates in diagnostics and treatment of tachyarrhythmias and bradyarrhythmias, all in the context of congenital anatomy, hemodynamics, and standard invasive palliations for congenital heart disease.

Lifespan Perspective on Congenital Heart Disease Research: JACC State-of-the-Art Review

More than 90% of patients with congenital heart disease (CHD) are nowadays surviving to adulthood and adults account for over two-thirds of the contemporary CHD population in Western countries. Although outcomes are improved, surgery does not cure CHD. Decades of longitudinal observational data are currently motivating a paradigm shift toward a lifespan perspective and proactive approach to CHD care. The aim of this review is to operationalize these emerging concepts by presenting new constructs in CHD research. These concepts include long-term trajectories and a life course epidemiology framework. Focusing on a precision health, we propose to integrate our current knowledge on the genome, phenome, and environome across the CHD lifespan. We also summarize the potential of technology, especially machine learning, to facilitate longitudinal research by embracing big data and multicenter lifelong data collection.

New developments in catheter ablation for patients with congenital heart disease

Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material. Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges. Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.

Efficacy and safety of Danhong injection on endothelial function and inflammatory factors after the percutaneous coronary intervention for coronary heart disease: A protocol of systematic review and meta-analysis of randomized controlled trials

BACKGROUND

To systematically review the effects of Danhong injection on endothelial function and inflammatory factors after the percutaneous coronary intervention (PCI) for coronary heart disease (CHD) and to provide a basis for further research.

METHODS

Through computer retrieval, including PubMed, Embase, the Cochrane Library, CNKI, Wan Fang Data, VIP, SinoMed were retrieved on a computer. Randomized controlled trials (RCTs) on the effects of Danhong injection on endothelial function and inflammatory factors after PCI for CHD were collected in strict accordance with the pre-established inclusion and exclusion criteria. Chinese and English literatures in published from the establishment of each database to December 1, 2019, were retrieved by combining subject headings and free terms. Literatures were screened out by 2 researchers independently, and the risk of bias was assessed by 2 independent researchers by using the assessment tool for risk of bias as described Cochrane systematic reviewer's manual 5.1.0. Statistical analysis was performed by using Stata 14.0 software.

RESULTS

By collecting the existing evidence, this study would determine the effects of Danhong injection on endothelial function and inflammatory factors after PCI for CHD by meta-analysis.

CONCLUSION

Through this study, we will draw a definite conclusion on whether Danhong injection has significant effects on endothelial function and inflammatory factors after PCI for CHD. This conclusion will provide practical and scientific guidance for the use of Danhong injection after PCI for CHD.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42020165568.