Wasmer Kristina, Eckardt Lars
Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany.
Heart. 2016 Oct 15;102(20):1614-9. doi: 10.1136/heartjnl-2015-309068. Epub 2016 Jun 16.
Supraventricular arrhythmias are a frequent complication in adults with congenital heart disease (ACHD). The prevalence increases with time since surgery, complexity of the underlying defect, type of repair and older age at surgery. Arrhythmias are the most frequent reason for hospital admission and along with heart failure the leading cause of death. The arrhythmia-associated increase in morbidity and mortality makes their management a key task in patients with ACHD. Intra-atrial re-entry is the most frequent arrhythmia mechanism. Less common arrhythmia mechanisms are supraventricular tachycardias in the presence of an accessory pathway, atrioventricular nodal re-entrant tachycardia or focal tachycardias. Patient management includes stroke prevention, acute termination and prevention of arrhythmia recurrence. Acute treatment depends on patients' symptoms. In cases of haemodynamic instability, immediate cardioversion is warranted. For stable patients, acute treatment includes rate control and termination by antiarrhythmic drugs or electrical cardioversion. Following a symptomatic arrhythmia, catheter ablation or treatment with antiarrhythmic drugs is recommended to prevent recurrences. Advances in mapping and ablation technology are now associated with high success rates of catheter ablation. In patients with a complex substrate recurrence rates of 50% remain high. However, in the presence of side effects and complications associated with long-term antiarrhythmic drug therapy, redo procedures are encouraged by current guidelines.
室上性心律失常是先天性心脏病（ACHD）成人患者常见的并发症。其患病率随术后时间、潜在缺陷的复杂性、修复类型以及手术时年龄的增长而增加。心律失常是住院的最常见原因，与心力衰竭一起是主要死因。心律失常导致的发病率和死亡率增加，使其管理成为ACHD患者的一项关键任务。房内折返是最常见的心律失常机制。较少见的心律失常机制包括存在旁路时的室上性心动过速、房室结折返性心动过速或局灶性心动过速。患者管理包括预防中风、急性终止和预防心律失常复发。急性治疗取决于患者症状。在血流动力学不稳定的情况下，应立即进行心脏复律。对于稳定的患者，急性治疗包括通过抗心律失常药物或电复律进行心率控制和终止心律失常。在出现有症状的心律失常后，建议进行导管消融或使用抗心律失常药物治疗以预防复发。目前，标测和消融技术的进步与导管消融的高成功率相关。在具有复杂基质的患者中，50%的复发率仍然很高。然而，鉴于长期抗心律失常药物治疗存在副作用和并发症，当前指南鼓励进行再次手术。
