V course on adult congenital heart disease

doi:10.15406/jccr.2015.02.00088

Journal of

eISSN: 2373-4396

Cardiology & Current Research

Proceeding Volume 3 Issue 1

V course on adult congenital heart disease

Rosaria Barracano

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Department of Cardiology, Italy

Correspondence: Rosaria Barracano, Department of Cardiology, Majoring in cardiology at AORN Monaldi, Avellino Area, Italy

Received: March 19, 2015 | Published: June 26, 2015

Citation: Barracano R. V course on adult congenital heart disease. J Cardiol Curr Res. 2015;3(1):9-11. DOI: 10.15406/jccr.2015.02.00088

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Proceeding

Absence of symptoms and clinical events until 14.08.2014 when he felt palpitation during strenuous physical activity (running).

ECG recorded at Sessa Aurunca Hospital showed monomorphic ventricular tachycardia

Successful Electrical Cardioversion with 200 J DC Shock

Ecg After Electrical Cardioversion

Asymptomatic

63 KG, 171 CM, B.P. 86/50 MMHG.
Systolic Murmur: 4/6 over the left third and fourth intercostal spaces along the sternal border.
ECG: HR 57 BPM. PR = 180 MSEC. QRS = 150 MSEC. Complete Right Bundle Branch Block With Secondary Abnormalities Of The Ventricular Repolarization.

Residual mild VSD.

No residual RVOT obstruction.

Echocardiography

Residual mild VSD.
No residual right outflow tract obstruction.
Good biventricular size and function.
Slight biatrial dilatation.

What guidelines says

ESC Guidelines for the management of grown-up congenital heart disease (new version 2010).

Sudden cardiac death (SCD) in GUCH

SCD is of particular concern IN GUCH patients.
Five defects with greatest known risk:
1. Repaired Tetralogy of Fallot,
2. TGA with atrial switch,
3. Congenitally corrected TGA,
4. Aortic Stenosis,
Univentricular syncope is a warning event requiring careful evaluation of arrthythmia.
Although various risk factors have been defined, algorithms for risk assessement and indications for ICD implantation have so far not been well established.

Atrial/ventricular tachycardia and SCD in TOF

This is related to progressive haemodynamic problems and/or surgical scarring, and thus is seen with increasing frequency with longer follow-up. SCD is reported in 1-6% of cases [in most instances due to VT/ventricular fibrillation (VF)], accounting for approximately a third to a half of late deaths.

Current guidelines for the prevention of scdgive the following recommendations for patients with CHD: ICD

Implantation is indicated in survivors of cardiac arrest after exclusion of reversible causes (IB9).
Patients with spontaneous sustained ventricular tachycardia (VT) should undergo invasive haemodynamic and EP evaluation.
Recommended therapy includes catheter ablation or surgical resection to eliminate VT. If that is not successful, ICD implantation is recommended (IC9).
Invasive haemodynamic and EP evaluation is reasonable in patients with unexplained syncope and impaired ventricular function. In the absence of a defined and reversible cause, ICD implantation is reasonable (IIaB9).
EP testing may be considered for patients with ventricular couplets or non-sustained VT to determine the risk of sustained VT (IIbC9).
Prophylactic antiarrhythmic therapy is not indicated for asymptomatic patients with isolated premature ventricular beats (IIIC9).

“The complex anatomy and history of multiple previous surgeries in adults with congenital heart disease pose many limitations and technical challenges related to the placement of a pacemaker or AICD.”

Aicd implantation increases thromboembolic risk

202 patients with documented intracardiac shunts

Baseline risk of systemic thromboemboli in pts with intracardiac shunts was 0.5% to 0.7% per year.
Transvenous PMK or ICD leads increased this risk >2 fold.
Importance of an epicardial approach.