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Cardiac Arrhythmias and Their Non-Pharmacological Treatment: An Overview

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Abstract

Arrhythmias represent a significant cause of morbidity and mortality in CHD. They can occur in each phase of the natural history of the disease, from the prenatal period to the late follow-up. Their relevance is increasing especially as a consequence of the good results achieved by corrective surgery, with more and more patients reaching adulthood with the possibility of developing long-term complications, often represented by arrhythmias. Their substrate can depend on the congenital abnormality itself or on surgical scars consequent to its correction, or both. To understand mechanisms underlying arrhythmias, knowledge of the physiology of the normal cardiac conduction system is necessary. This chapter gives an overview of different arrhythmias and their incidence according to the subtype of CHD, also providing basic concepts about their non-pharmacological treatment, in particular cardiac pacing for the treatment of bradyarrhythmias and ablation and ICD implantation for the treatment of tachyarrhythmias. Special emphasis is given to the particular features that arrhythmias have when they occur in congenitally abnormal hearts and in particular to the peculiar aspects of device implantation and arrhythmia ablation in the field of CHD compared to normally structured hearts.

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References

  1. Warnes CA, Liberthson R, Danielson GK, Dore A, Harris L, Hoffman JI, Somerville J, Williams RG, Webb GD. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol. 2001;37(5):1170–5.

    Article  CAS  PubMed  Google Scholar 

  2. Harrison DA, Connelly M, Harris L, Luk C, Webb GD, McLaughlin PR. Sudden cardiac death in the adult with congenital heart disease. Can J Cardiol. 1996;12(11):1161–3.

    CAS  PubMed  Google Scholar 

  3. Sarubbi B, Pietra S, Somerville J. Sudden death in grown-up congenital heart (GUCH) patients: a 26-year population-based study [abstract]. J Am Coll Cardiol. 1999;33(Suppl A):538.

    Google Scholar 

  4. Silka MJ, Hardy BG, Menashe VD, Morris CD. A population-based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol. 1998;32(1):245–51.

    Article  CAS  PubMed  Google Scholar 

  5. Walsh EP, Cecchin F. Arrhythmias in adult patients with congenital heart disease. Circulation. 2007;115(4):534–45.

    Article  PubMed  Google Scholar 

  6. Keith A, Flack M. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol. 1907;41(Pt 3):172–89.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Tawara S. Das Reizleitungssystem des Saugetierherzens. Jena: Gustav Fischer; 1906.

    Google Scholar 

  8. His W Jr. The story of the atrioventricular bundle with remarks concerning embryonic heart activity. J Hist Med Allied Sci. 1949;4(3):319–33.

    Article  PubMed  Google Scholar 

  9. Purkinje JE. Mikrosckopisch neurologisce Beobachtungen. Archiv Fur Anatomie Physiolgie und Wissenchaftliche Medizin. 1845;12:281.

    Google Scholar 

  10. Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Nd G, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm. 2014;11(10):e102–65. https://doi.org/10.1016/j.hrthm.2014.05.009; Epub 2014 May 9.

    Article  PubMed  Google Scholar 

  11. Bink-Boelkens MT, Meuzelaar KJ, Eygelaar A. Arrhythmias after repair of secundum atrial septal defect: the influence of surgical modification. Am Heart J. 1988;115(3):629–33.

    Article  CAS  PubMed  Google Scholar 

  12. Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med. 1999;340(11):839–46.

    Article  CAS  PubMed  Google Scholar 

  13. Kirsh JA, Walsh EP, Triedman JK. Prevalence of and risk factors for atrial fibrillation and intra-atrial reentrant tachycardia among patients with congenital heart disease. Am J Cardiol. 2002;90(3):338–40.

    Article  PubMed  Google Scholar 

  14. Murphy JG, Gersh BJ, McGoon MD, Mair DD, Porter CJ, Ilstrup DM, McGoon DC, Puga FJ, Kirklin JW, Danielson GK. Long-term outcome after surgical repair of isolated atrial septal defect. N Engl J Med. 1990;323(24):1645–50.

    Article  CAS  PubMed  Google Scholar 

  15. Ho SY, Rossi MB, Mehta AV, Hegerty A, Lennox S, Anderson RH. Heart block and atrioventricular septal defect. Thorac Cardiovasc Surg. 1985;33(6):362–5.

    Article  CAS  PubMed  Google Scholar 

  16. Godman MJ, Roberts NK, Izukawa T. Late postoperative conduction disturbances after repair of ventricular septal defect and tetralogy of Fallot. Analysis by his bundle recordings. Circulation. 1974;49(2):214–21.

    Article  CAS  PubMed  Google Scholar 

  17. Houyel L, Vaksmann G, Fournier A, Davignon A. Ventricular arrhythmias after correction of ventricular septal defects: importance of surgical approach. J Am Coll Cardiol. 1990;16(5):1224–8.

    Article  CAS  PubMed  Google Scholar 

  18. Baharati S, Lev M. The myocardium. The conduction system, and general sequelae after surgery for congenital heart disease. In: Engle MA, Perloff JK, editors. Congenital heart disease after surgery: benefits, residua, sequelae: York Medical Books; 1983.

    Google Scholar 

  19. Natterson PD, Perloff JK, Klitzner TS, Stevenson WG. Electrophysiologic abnormalities: unoperated occurrence and postoperative residua and sequelae. In: Perloff JK, Child JS, editors. Congenital heart disease in adults. 2nd ed. Philadelphia, PA: WB Saunders; 1998.

    Google Scholar 

  20. Karpawich PP, Jackson WL, Cavitt DL, Perry BL. Late-onset unprecedented complete atrioventricular block after tetralogy of Fallot repair: electrophysiologic findings. Am Heart J. 1987;114(3):654–6.

    Article  CAS  PubMed  Google Scholar 

  21. Khairy P, Aboulhosn J, Gurvitz MZ, et al. Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation. 2010;122:868–75.

    Article  PubMed  Google Scholar 

  22. Cuypers JA, Menting ME, Konings EE, et al. Unnatural history of tetralogy of Fallot: prospective follow-up of 40 years after surgical correction. Circulation. 2014;130:1944–53.

    Article  PubMed  Google Scholar 

  23. Drago F, Pazzano V, Di Mambro C, Russo MS, Palmieri R, Silvetti MS, Giannico S, Leonardi B, Amodeo A, Di Ciommo VM. Role of right ventricular three-dimensional electroanatomic voltage mapping for arrhythmic risk stratification of patients with corrected tetralogy of Fallot or other congenital heart disease involving the right ventricular outflow tract. Int J Cardiol. 2016;222:422–9.

    Article  PubMed  Google Scholar 

  24. Daliento L, Corrado D, Buja G, John N, Nava A, Thiene G. Rhythm and conduction disturbances in isolated, congenitally corrected transposition of the great arteries. Am J Cardiol. 1986;58(3):314–8.

    Article  CAS  PubMed  Google Scholar 

  25. Wilkinson JL, Smith A, Lincoln C, Anderson RH. Conducting tissues in congenitally corrected transposition with situs inversus. Br Heart J. 1978;40(1):41–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Rhodes LA, Wernovsky G, Keane JF, Mayer JE Jr, Shuren A, Dindy C, Colan SD, Walsh EP. Arrhythmias and intracardiac conduction after the arterial switch operation. J Thorac Cardiovasc Surg. 1995;109(2):303–10.

    Article  CAS  PubMed  Google Scholar 

  27. Cromme-Dijkhuis AH, Hess J, Hählen K, Henkens CM, Bink-Boelkens MT, Eygelaar AA, Bos E. Specific sequelae after Fontan operation at mid- and long-term follow-up. Arrhythmia, liver dysfunction, and coagulation disorders. J Thorac Cardiovasc Surg. 1993;106(6):1126–32.

    CAS  PubMed  Google Scholar 

  28. Peters NS, Somerville J. Arrhythmias after the Fontan procedure. Br Heart J. 1992;68(2):199–204.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Balaji S, Gewillig M, Bull C, de Leval MR, Deanfield JE. Arrhythmias after the Fontan procedure. Comparison of total cavopulmonary connection and atriopulmonary connection. Circulation. 1991;84(5 Suppl):III162–7.

    CAS  PubMed  Google Scholar 

  30. Cecchin F, Johnsrude CL, Perry JC, Friedman RA. Effect of age and surgical technique on symptomatic arrhythmias after the Fontan procedure. Am J Cardiol. 1995;76(5):386–91.

    Article  CAS  PubMed  Google Scholar 

  31. Gelatt M, Hamilton RM, McCrindle BW, Gow RM, Williams WG, Trusler GA, Freedom RM. Risk factors for atrial tachyarrhythmias after the Fontan operation. J Am Coll Cardiol. 1994;24(7):1735–41.

    Article  CAS  PubMed  Google Scholar 

  32. Attenhofer Jost CH, Connolly HM, Edwards WD, Hayes D, Warnes CA, Danielson GK. Ebstein’s anomaly—review of a multifaceted congenital cardiac condition. Swiss Med Wkly. 2005;135(19-20):269–81.

    CAS  PubMed  Google Scholar 

  33. Berntsen RF1, Gjesdal KT, Aass H, Platou ES, Hole T, Orning OM. Radiofrequency catheter ablation of two right Mahaïm-like accessory pathways in a patient with Ebstein’s anomaly. J Interv Card Electrophysiol. 1998;2(3):293–9.

    Article  CAS  PubMed  Google Scholar 

  34. Udink ten Cate F, Breur J, Boramanand N, Crosson J, Friedman A, Brenner J, et al. Endocardial and epicardial steroid lead pacing in the neonatal and paediatric age group. Heart. 2002;88:392–6.

    Article  CAS  PubMed  Google Scholar 

  35. Kammeraad JAE, Rosenthal E, Bostock J, Rogers J, Sreeram N. Endocardial pacemaker implantation in infants weighing ≤ 10 kilograms. Pacing Clin Electrophysiol. 2004;27:1466–74.

    Article  PubMed  Google Scholar 

  36. Fortescue EB, Berul CI, Cecchin F, Walsh EP, Triedman JK, Alexander ME. Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm. 2004;1:150–9.

    Article  PubMed  Google Scholar 

  37. Fortescue EB, Berul CI, Cecchin F, Walsh EP, Triedman JK, Alexander ME. Comparison of modern steroid-eluting epicardial and thin transvenous pacemaker leads in pediatric and congenital heart disease patients. J Interv Card Electrophysiol. 2005;14:27–36.

    Article  PubMed  Google Scholar 

  38. Silvetti MS, Drago F, Grutter G, De Santis A, Di Ciommo V, Ravà L. Twenty years of cardiac pacing in paediatric age: 515 pacemakers and 480 leads implanted in 292 patients. Europace. 2006;8:530–6.

    Article  PubMed  Google Scholar 

  39. Silvetti MS, Drago F, Marcora S, Ravà L. Outcome of single-chamber, ventricular pacemakers with transvenous leads implanted in children. Europace. 2007;9:894–9.

    Article  PubMed  Google Scholar 

  40. Silvetti MS, Drago F, De Santis A, Grutter G, Ravà L, Monti L, et al. Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants. Europace. 2007;9:426–31.

    Article  PubMed  Google Scholar 

  41. Khairy P, Landzberg MJ, Gatzoulis MA, Mercier LA, Fernandes SM, Cotè JM, et al. Transvenous pacing leads and systemic thromboembolism in patients with intracardiac shunts. A multicenter study. Circulation. 2006;113:2391–7.

    Article  PubMed  Google Scholar 

  42. Webster G, Margossian R, Alexander ME, Cecchin F, Triedman JK, Walsh EP, et al. Impact of transvenous ventricular pacing leads on tricuspid regurgitation in pediatric and congenital heart disease patients. J Interv Card Electrophysiol. 2008;21:65–8.

    Article  PubMed  Google Scholar 

  43. Bar-Cohen Y, Berul CI, Alexander ME, Fortescue EB, Walsh EP, Triedman JK, et al. Age, size, and lead factors alone do not predict venous obstruction in children and young adults with transvenous lead systems. J Cardiovasc Electrophysiol. 2006;17:754–9.

    Article  PubMed  Google Scholar 

  44. Karpavich PP. Technical aspects of pacing in adult and pediatric congenital heart disease. Pacing Clin Electrophysiol. 2008;31:S28–31.

    Article  Google Scholar 

  45. Gebauer RA, Tomek V, Salameh A, Marek J, Chaloupecky V, Gebauer R, et al. Predictors of left ventricular remodelling and failure in right ventricular pacing in the young. Eur Heart J. 2009;30:1097–104.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Alexander ME, Cecchin F, Walsh EP, Triedman JK, Bevilacqua LM, Berul CI. Implications of implantable cardioverter defibrillator therapy in congenital heart disease and pediatrics. J Cardiovasc Electrophysiol. 2004;15:72–6.

    Article  PubMed  Google Scholar 

  47. Sherwin ED1, Triedman JK, Walsh EP. Update on interventional electrophysiology in congenital heart disease: evolving solutions for complex hearts. Circ Arrhythm Electrophysiol. 2013;6(5):1032–40.

    Article  PubMed  Google Scholar 

  48. Atallah J, Erickson CC, Cecchin F, Dubin AM, Law IH, Cohen MI, Lapage MJ, Cannon BC, Chun TU, Freedenberg V, Gierdalski M, Berul CI. Pediatric and Congenital Electrophysiology Society (PACES). Multi-institutional study of implantable defibrillator lead performance in children and young adults: results of the Pediatric Lead Extractability and Survival Evaluation (PLEASE) study. Circulation. 2013;127(24):2393–402. https://doi.org/10.1161/CIRCULATIONAHA.112.001120; Epub 2013 May 21.

    Article  PubMed  Google Scholar 

  49. Drago F, Fazio G, Silvetti MS, Oricchio G, Michielon G. A successfully novel ICD implantation and medical treatment in a child with LQT syndrome and self-limiting ventricular fibrillation. Int J Cardiol. 2007;118:e108–12.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Arrythmia Unit, Medical-Surgical Department of Paediatric Cardiology, Bambino Gesù Children’s Hospital and Research Institute, Rome, Italy

    Vincenzo Pazzano, Fabio Anselmo Saputo, Letizia Verticelli, Ilaria Tamburri & Antonio Longoni

Authors
  1. Vincenzo Pazzano
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  2. Fabio Anselmo Saputo
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  3. Letizia Verticelli
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  4. Ilaria Tamburri
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  5. Antonio Longoni
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Correspondence to Fabio Anselmo Saputo .

Editor information

Editors and Affiliations

  1. Pediatric and Adult Congenital Heart Disease Center, IRCCS Policlinico San Donato University Hospital, San Donato Milanese (MI), Italy

    Serena Francesca Flocco

  2. Policlinico S.Orsola-Malpighi, Bologna, Italy

    Angelo Lillo

  3. Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy

    Federica Dellafiore

  4. Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium

    Eva Goossens

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Pazzano, V., Saputo, F.A., Verticelli, L., Tamburri, I., Longoni, A. (2019). Cardiac Arrhythmias and Their Non-Pharmacological Treatment: An Overview. In: Flocco, S., Lillo, A., Dellafiore, F., Goossens, E. (eds) Congenital Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-78423-6_10

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  • DOI: https://doi.org/10.1007/978-3-319-78423-6_10

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