Abstract
Arrhythmias are a leading cause of morbidity in adults with congenital heart disease.
Numerous challenges to managing arrhythmias include vascular access issues, intracardiac
shunts, unconventional locations of the conduction system, and anatomical complexities.
Technological advances are improving our ability to diagnose and treat arrhythmias.
Implantable loop recorders and various technologies developed for consumers to record
electrocardiographic tracings using smartphone applications, watches, and dedicated
portable devices are expanding our armamentarium of diagnostic tools. Remote magnetic-guided
catheter ablation is enhancing access to otherwise difficult to reach arrhythmia substrates.
Cryoablation allows perinodal arrhythmias to be safely treated in patients with displaced
or difficult to predict locations of the atrioventricular conduction system. Interventions
that minimize radiation exposure to near 0 levels are gaining interest and pulmonary
vein isolation procedures to treat atrial fibrillation are increasingly performed.
Cardiac implantable electronic devices compatible with magnetic resonance imaging
have become the norm. Subcutaneous defibrillators and leadless pacemakers are providing
effective solutions to patients in whom transvenous leads are contraindicated or not
desired. His-bundle pacing is emerging as a viable option to provide more physiological
pacing. Progressive advances in multicomponent communicating leadless devices carry
the promise of providing leadless dual chamber pacing and cardiac resynchronization
therapy in the near future. The safety of transvenous lead extraction procedures is
likely to improve with advances such as the low-pressure balloon to manage superior
vena cava lacerations. Awareness of these developments and referral to sites with
dedicated expertise could contribute to further improving outcomes in adults with
congenital heart disease.
Résumé
Les arythmies sont une des principales causes de morbidité chez les adultes atteints
d’une cardiopathie congénitale. Les nombreux défis dans la prise en charge des arythmies
comprennent les problèmes liés à l’accès vasculaire, les shunts intracardiaques, la
configuration inhabituelle du système de conduction et les complexités anatomiques.
Les avancées technologiques améliorent notre capacité à diagnostiquer et à traiter
les arythmies. Les enregistreurs en boucle implantables et diverses technologies mises
au point pour permettre aux consommateurs d’enregistrer des tracés électrocardiographiques
au moyen d’applications pour téléphones intelligents, de montres ou d’appareils portables
dédiés élargissent notre arsenal d’outils diagnostiques. L’ablation à distance par
cathéter guidé magnétiquement améliore l’accès à des substrats anatomiques de l’arythmie
qui seraient autrement difficiles à atteindre. La cryoablation permet de traiter sans
danger les arythmies périnodales chez les patients dont le système de conduction auriculoventriculaire
est déplacé ou localisé de façon difficilement prévisible. Les interventions permettant
de réduire au minimum l’exposition au rayonnement, à des niveaux presque nuls, suscitent
de plus en plus d’intérêt, et les interventions d’isolement des veines pulmonaires
pour le traitement de la fibrillation auriculaire sont de plus en plus pratiquées.
Les dispositifs cardiaques électroniques implantables compatibles avec l’imagerie
par résonance magnétique sont devenus la norme. Les défibrillateurs sous-cutanés et
les stimulateurs cardiaques sans électrodes offrent des solutions efficaces aux patients
chez qui les électrodes transveineuses sont contre-indiquées ou non souhaitées. La
stimulation du faisceau de His s’affirme peu à peu comme une option viable de stimulation
plus physiologique. Les avancées progressives dans la conception de dispositifs multicomposants
de communication sans électrodes permettent d’espérer l’avènement prochain de traitements
comme la stimulation double chambre et la resynchronisation cardiaque sans électrodes.
L’innocuité des interventions d’extraction des électrodes par voie intraveineuse sera
probablement améliorée grâce aux avancées comme l’utilisation du ballon à faible pression
dans la prise en charge des lacérations de la veine cave supérieure. La connaissance
de ces progrès et l’orientation vers des sites fondés sur une expertise spécialisée
pourraient contribuer à la poursuite de l’amélioration des résultats thérapeutiques
pour les adultes atteints de cardiopathie congénitale.
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Article info
Publication history
Published online: October 04, 2019
Accepted:
June 18,
2019
Received:
April 2,
2019
Footnotes
See page 1718 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
