Lundqvist Carina Blomström, Potpara Tatjana S, Malmborg Helena
Institution of Medical Science, Uppsala University, Uppsala, Sweden.
School of Medicine, University of Belgrade, Serbia; Cardiology Clinic, Clinical Center of Serbia.
Arrhythm Electrophysiol Rev. 2017 Jun;6(2):42-49. doi: 10.15420/aer.2016:29:3.
An increasing number of patients with congenital heart disease survive to adulthood; such prolonged survival is related to a rapid evolution of successful surgical repairs and modern diagnostic techniques. Despite these improvements, corrective atrial incisions performed at surgery still lead to subsequent myocardial scarring harbouring a potential substrate for macro-reentrant atrial tachycardia. Macroreentrant atrial tachycardias are the most common (75 %) type of supraventricular tachycardia (SVT) in patients with adult congenital heart disease (ACHD). Patients with ACHD, atrial tachycardias and impaired ventricular function - important risk factors for sudden cardiac death (SCD) - have a 2-9 % SCD risk per decade. Moreover, ACHD imposes certain considerations when choosing antiarrhythmic drugs from a safety aspect and also when considering catheter ablation procedures related to the inherent cardiac anatomical barriers and required expertise. Expert recommendations for physicians managing these patients are therefore mandatory. This review summarises current evidence-based developments in the field, focusing on advances in and general recommendations for the management of ACHD, including the recently published recommendations on management of SVT by the European Heart Rhythm Association.
越来越多的先天性心脏病患者存活至成年期；这种延长的生存期与成功外科修复和现代诊断技术的迅速发展有关。尽管有这些进步，但手术中进行的矫正性心房切口仍会导致随后的心肌瘢痕形成，为大折返性房性心动过速提供了潜在的基质。大折返性房性心动过速是成人先天性心脏病（ACHD）患者中最常见（75%）的室上性心动过速（SVT）类型。患有ACHD、房性心动过速和心室功能受损（心脏性猝死（SCD）的重要危险因素）的患者每十年发生SCD的风险为2-9%。此外，从安全角度选择抗心律失常药物时以及考虑与心脏固有解剖屏障和所需专业知识相关的导管消融手术时，ACHD都有特定的注意事项。因此，为管理这些患者的医生提供专家建议是必不可少的。本综述总结了该领域当前基于证据的进展，重点关注ACHD管理方面的进展和一般建议，包括欧洲心律协会最近发布的关于SVT管理的建议。
