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Arrhythmias in adult congenital heart disease: the year in review

Mondésert, Blandine; Abadir, Sylvia; Khairy, Paul

Current Opinion in Cardiology: May 2013 - Volume 28 - Issue 3 - p 354–359
doi: 10.1097/HCO.0b013e32835fb7c2
CARDIAC FAILURE: Edited by David Feldman and Josef Stehlik

Purpose of review Management of arrhythmias is an integral component of care for adults with congenital heart disease (CHD). Our objective was to highlight the important advances from the year 2012 regarding arrhythmias in adult CHD, with a focus on diagnostic considerations, acute management, catheter ablation, and device therapy.

Recent findings During the course of 2012, Holter studies suggested that routine screening was helpful in guiding the clinical decisions for certain patient subgroups, such as adults with tetralogy of Fallot. Supportive evidence was provided for the common practice of anticoagulation and/or screening for intracardiac thrombosis by transesophageal echocardiography prior to electrically cardioverting atrial tachyarrhythmias. Advances in catheter ablation, particularly robotic magnetic navigation, offer new hope for patients in whom access to arrhythmia substrates is not feasible by standard means. The subcutaneous defibrillator emerged as an innovative solution of great interest to the patients at risk of sudden death in whom transvenous lead implantation is unachievable or contraindicated. Finally, 2012 ended with a major milestone: the establishment of physician certification in adult CHD by the American Board of Medical Specialties.

Summary The year 2012 witnessed important advances in the diagnosis and management of arrhythmias in adults with CHD.

Adult Congenital Heart Center and Electrophysiology Service, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada

Correspondence to Dr Paul Khairy, MD, PhD, Adult Congenital Heart Center, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec H1T 1C8, Canada. Tel: +1 514 376 3330; 3652; fax: +1 514 593 2581; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.