70. Mapping and Ablation of Ventricular Arrhythmias in Patients with Congenital Heart Disease

  1. Mohammad Shenasa MD2,
  2. Gerhard Hindricks MD3,
  3. Martin Borggrefe MD4,
  4. Günter Breithardt MD5 and
  5. Mark E. Josephson MD6
  1. Edward P. Walsh

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch70

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Walsh, E. P. (2013) Mapping and Ablation of Ventricular Arrhythmias in Patients with Congenital Heart Disease, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch70

Editor Information

  1. 2

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 3

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 4

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 5

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 6

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. Children's Hospital Boston and Harvard Medical School, Boston, MA, USA

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585

SEARCH

Keywords:

  • ablation;
  • arrhythmia mapping;
  • congenital heart disease;
  • Ebstein's anomaly;
  • implantable cardioverter-defibrillator;
  • sudden cardiac death;
  • tetralogy of Fallot;
  • ventricular tachycardia

Summary

Ventricular tachyarrhythmias are an unusual but potentially devastating late complication of congenital heart disease. They appear to arise from the complex myocardial substrate created by chronic pressure and volume loads, combined with the disordered intraventricular conduction that results from surgical scarring and abnormal ventricular anatomy. Risk factors are understood in a general sense, but accurate identification of patients needing aggressive pre-emptive therapy remains challenging. Although defibrillator implant remains the therapeutic mainstay in most cases, growing experience with tachycardia mapping in specific defects (e.g., tetralogy of Fallot) has greatly improved our understanding of these arrhythmias, and expanded the treatment options to include catheter and surgical ablation in selected cases. This chapter reviews the clinical data on ventricular arrhythmias in congenital heart disease, provides an update on tachycardia mapping and outlines the current management options with a focus on ablation strategies.