1
|
Bessière F, Waldmann V, Combes N, Metton O, Dib N, Mondésert B, O'Leary E, De Witt E, Carreon CK, Sanders SP, Moore JP, Triedman J, Khairy P. Ventricular Arrhythmias in Adults With Congenital Heart Disease, Part II: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1121-1130. [PMID: 37673513 DOI: 10.1016/j.jacc.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 09/08/2023]
Abstract
There are marked variations in the incidence of sudden cardiac death (SCD) and in the substrates for ventricular arrhythmias (VAs) across the gamut of congenital heart defects. In this 2-part review, patients with higher-risk forms of congenital heart disease (CHD) were conceptually categorized into those with discrete anatomic isthmuses for macro-reentrant ventricular tachycardia (VT) (Group A) and those with more diffuse or less well-defined substrates (Group B) that include patchy or extensive myocardial fibrosis. The latter category encompasses CHD lesions such as Ebstein anomaly, transposition of the great arteries with a systemic right ventricle (RV), and congenital aortic stenosis. For Group B patients, polymorphic VT and ventricular fibrillation account for a higher proportion of VA. The prognostic value of programmed ventricular stimulation is less well established, and catheter ablation plays a less prominent role. As cardiomyopathies evolve over time, pathophysiological mechanisms for VA among Groups A and B become increasingly blurred.
Collapse
Affiliation(s)
- Francis Bessière
- Electrophysiology Unit, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Pediatric and Congenital Heart Disease Medico-Surgical Unit, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, LabTau, INSERM, Lyon, France.
| | - Victor Waldmann
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Pediatric and Congenital Medico-Surgical Unit, Necker Hospital, Paris, France; Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris Cité, PARCC, INSERM, Paris, France
| | - Nicolas Combes
- Clinique Pasteur, Toulouse, France; Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Olivier Metton
- Pediatric and Congenital Heart Disease Medico-Surgical Unit, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Nabil Dib
- Division of Electrophysiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Blandine Mondésert
- Division of Electrophysiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Edward O'Leary
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth De Witt
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chrystalle Katte Carreon
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen P Sanders
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - John Triedman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Khairy
- Division of Electrophysiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
2
|
Late outcome, therapy and systemic ventricular function in patients with a systemic right ventricle: data of the German National Register for Congenital Heart Defects. Cardiol Young 2022; 32:1235-1245. [PMID: 34658317 DOI: 10.1017/s1047951121003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adults with systemic right ventricle have a significant risk for long-term complications such as arrhythmias or heart failure. METHODS A nationwide retrospective study based on the German National Register for Congenital Heart Disease was performed. Patients with transposition of the great arteries after atrial switch operation or congenitally corrected TGA were included. RESULTS Two hundred and eight-five patients with transposition of the great arteries after atrial switch operation and 95 patients with congenitally corrected transposition of the great arteries were included (mean age 33 years). Systolic function of the systemic ventricle was moderately or severely reduced in 25.5 % after atrial switch operation and in 35.1% in patients with congenitally corrected transposition. Regurgitation of the systemic atrioventricular valve was present in 39.5% and 43.2% of the cases, respectively. A significant percentage of patients also had a history for supraventricular or ventricular arrhythmias. However, polypharmacy of cardiovascular drugs was rare (4.5%) and 38.5 % of the patients did not take any cardiovascular medication. The amount of cardiovascular drugs taken was associated with NYHA class as well as systemic right ventricular dysfunction. Patients with congenitally corrected transposition were more likely to receive pharmacological treatment than patients after atrial switch operation. CONCLUSION A significant portion of patients with systemic right ventricle suffer from a relevant systemic ventricular dysfunction, systemic atrioventricular valve regurgitation, and arrhythmias. Despite this, medication for heart failure treatment is not universally used in this cohort. This emphasises the need for randomised trials in patient with systemic right ventricle.
Collapse
|
3
|
Stewart MH, Macicek SL, Morin DP. Implantable Cardioverter-defibrillators in Adult Congenital Heart Disease. J Innov Card Rhythm Manag 2018; 9:3172-3181. [PMID: 32494493 PMCID: PMC7252815 DOI: 10.19102/icrm.2018.090601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
With improved surgical techniques and medical therapies, many patients who are born with complex congenital heart defects are now living well into adulthood. As these patients age, an increasingly common cause of mortality is sudden cardiac death (SCD) from ventricular tachyarrhythmias. The implantable cardioverter-defibrillator (ICD) is a therapy with the ability to prevent some of these deaths; however, there are many diagnostic and technical challenges that remain in the congenital heart disease (CHD) population. We performed a literature review, searching PubMed for articles that examined the role of ICDs in CHD. We herein present the evidence for when to place an ICD in CHD patients, stratified by subtype as relevant. Then, we discuss the technical challenges and complications that are unique to this patient population. We conclude that, despite active work in the area, more research is needed given the small event rates and clinical variability within CHD populations.
Collapse
Affiliation(s)
- Merrill H Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Scott L Macicek
- Department of Pediatric Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Daniel P Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
| |
Collapse
|