Critical Care Management of the ACHD Patient with Arrhythmias and Conduction Disorders

  • Ian LindsayEmail author
  • Jeremy P. Moore
  • Seshadri Balaji
Part of the Congenital Heart Disease in Adolescents and Adults book series (CHDAA)


Dysrhythmias represent one of the major causes of morbidity and mortality in ACHD patients, second only to heart failure, in both the acute and chronic settings. Several factors predispose this patient group to dysrhythmias, including congenital variations in the native conduction system, electromechanical effects of multiple surgical procedures, and altered hemodynamics. ACHD patients suffer from a wide array of rhythm disturbances, both supraventricular and ventricular, as well as tachy and bradycardia. Multiple clinical scenarios may lead to an ACHD patient’s arrhythmia being addressed in the intensive care unit (ICU): primary admission for an acute rhythm issue, new onset arrhythmia or exacerbation of a chronic arrhythmia during admission for another illness, or postoperative disturbances after cardiac surgery. Many can lead to significant hemodynamic compromise if left untreated, and swift and accurate recognition and management of these arrhythmias is vital in the critically ill patient. The first set of PACES/HRS guidelines for dysrhythmia issues in ACHD patients was released in 2014 and is a useful evidence-based reference. This chapter begins with an overview of the diagnosis and management of the arrhythmias most likely to be encountered in the ACHD population in the ICU. The remainder of the chapter discusses specific clinical scenarios in which arrhythmia may play a key role, including the postoperative ICU and in the setting of device complications.


Adult congenital heart disease Arrhythmia Supraventricular tachycardia Atrial fibrillation Intra-atrial reentrant tachycardia Ventricular tachycardia Ventricular fibrillation Sinus node dysfunction Atrioventricular block Pacemaker Implantable cardioverter defibrillator 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Ian Lindsay
    • 1
    Email author
  • Jeremy P. Moore
    • 1
    • 2
  • Seshadri Balaji
    • 3
  1. 1.Department of CardiologyRonald Reagan UCLA Medical CenterLos AngelesUSA
  2. 2.Department of Pediatric CardiologyRonald Reagan UCLA Medical CenterLos AngelesUSA
  3. 3.Department of Pediatric CardiologyOHSU HospitalPortlandUSA

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