Abstract
Adults with congenital heart disease (CHD) are at risk for the development of arrhythmias. This study aimed to assess the incidence of unsuspected arrhythmias among adults with CHD identified on electrocardiograms (ECGs) and 24-h ambulatory electrocardiographic monitoring (Holter monitoring). A review of the cardiology database at the authors’ institution from July 2004 through December 2007 identified all clinic patients 18 years old or older who had a recent ECG and Holter monitoring. Data collection included diagnosis, ECG and Holter monitoring results, arrhythmias, and the presence or absence of symptoms. The review identified 140 patients. Analysis of the ECGs showed that 15% of the patients had an arrhythmia. These arrhythmias consisted of ectopy (6%), supraventricular tachycardia (SVT) (3%), pacemaker issues (2%), and previously unrecognized atrioventricular block (AVB) (1%). The majority of the patients with arrhythmias were asymptomatic (76%). Analysis of the Holter monitoring results showed that 31% of the patients had arrhythmias consisting of ectopy (17%), SVT (12%), ventricular tachycardia (7%), high-grade AVB (5%), and pacemaker issues (3%). Of the patients with arrhythmias, 80% were asymptomatic. Among the patients without arrhythmias on ECG, 26% had arrhythmias noted on Holter monitoring. Of the patients with multiple Holter monitorings performed, 34% had a new arrhythmia noted on repeat monitoring. In conclusion, arrhythmias were present in a significant number of adults with CHD, but the majority were asymptomatic. Among adults with CHD, even those with normal ECGs, arrhythmias were frequently detected on Holter monitoring. In addition, repeat Holter monitoring may identify significant arrhythmias over time.
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References
Marelli AJ, Mackie AS, Ionescu-Ittu R, Rahme E, Pilote L (2007) Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 115:163–172
Engelfriet P, Boersma E, Oechslin E, Tijssen J, Gatzoulis MA, Thilen U, Kaemmerer H, Moons P, Meijboom F, Popelova J, Laforest V, Hirsch R, Daliento L, Thaulow E, Mulder B (2005) The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5-year follow-up period. The Euro heart survey on adult congenital heart disease. Eur Heart J 26:2325–2333
Somerville J (1997) Management of adults with congenital heart disease: an increasing problem. Annu Rev Med 48:283–293
Walsh EP, Cecchin F (2007) Arrhythmias in adult patients with congenital heart disease. Circulation 115:534–545
Gelatt M, Hamilton RM, McCrindle BW, Connelly M, Davis A, Harris L, Gow RM, Williams WG, Trusler GA, Freedom RM (1997) Arrhythmia and mortality after the Mustard procedure: a 30-year single-center experience. J Am Coll Cardiol 29:194–201
Gatzoulis MA, Munk MD, Williams WG, Webb GD (2000) Definitive palliation with cavopulmonary or aortopulmonary shunts for adults with single-ventricle physiology. Heart Br Cardiac Soc 83:51–57
Schwerzmann M, Salehian O, Harris L, Siu SC, Williams WG, Webb GD, Colman JM, Redington A, Silversides CK (2009) Ventricular arrhythmias and sudden death in adults after a Mustard operation for transposition of the great arteries. Eur Heart J 30:1873–1879
Opotowsky AR, Siddiqi OK, Webb GD (2009) Trends in hospitalizations for adults with congenital heart disease in the U.S. J Am Coll Cardiol 54:460–467
Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD (2008) ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation 118:e714–e833
Walsh EP (2007) Interventional electrophysiology in patients with congenital heart disease. Circulation 115:3224–3234
Bouchardy J, Therrien J, Pilote L, Ionescu-Ittu R, Martucci G, Bottega N, Marelli AJ (2009) Atrial arrhythmias in adults with congenital heart disease. Circulation 120:1679–1686
Oechslin EN, Harrison DA, Connelly MS, Webb GD, Siu SC (2000) Mode of death in adults with congenital heart disease. Am J Cardiol 86:1111–1116
Pillutla P, Shetty KD, Foster E (2009) Mortality associated with adult congenital heart disease: trends in the U.S. population from 1979 to 2005. Am Heart J 158:874–879
Wong T, Davlouros PA, Li W, Millington-Sanders C, Francis DP, Gatzoulis MA (2004) Mechano-electrical interaction late after Fontan operation: relation between P-wave duration and dispersion, right atrial size, and atrial arrhythmias. Circulation 109:2319–2325
Capelli H (2006) Grown-up congenital heart disease: the problem of late arrhythmia and ventricular dysfunction. Prog Pediatr Cardiol 22:165–173
Warnes CA (2005) The adult with congenital heart disease: Born to be bad? J Am Coll Cardiol 46:1–8
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Rodriguez, F.H., Moodie, D.S., Neeland, M. et al. Identifying Arrhythmias in Adults With Congenital Heart Disease by 24-h Ambulatory Electrocardiography. Pediatr Cardiol 33, 591–595 (2012). https://doi.org/10.1007/s00246-012-0183-1
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DOI: https://doi.org/10.1007/s00246-012-0183-1