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Adult Congenital Heart Disease - Part 8

Chứng loạn nhịp tim là một phần của lịch sử "tự nhiên" của tổn thương tim bẩm sinh và sửa chữa phẫu thuật của họ. Mất xoang nhịp điệu là một trong những lý do phổ biến cho nhập viện. | Adult Congenital Heart Disease A Practical Guide Michael A. Gatzoulis Lorna Swan Judith Therrien George A. Pantely Copyright 2005 by Blackwell Publishing Ltd CHAPTER 23 Arrhythmia and Syncope Arrhythmia is part of the natural history of many congenital heart lesions and their surgical repairs. Loss of sinus rhythm is one of the more common reasons for hospital admission. Unfortunately in this group arrhythmias are often more difficult to detect slow intra-atrial re-entry may superficially appear like sinus rhythm associated with significant morbidity resistant to drug therapy and challenging to treat in the electrophysiologic laboratory. In addition palpitation alone can turn a young working adult into someone who is unable to hold down their job or function independently in the community. Supraventricular rhythm disturbances are by far the most common arrhythmias to affect this group. In a compromised heart a fast supraventricular rhythm can be as devastating as ventricular tachycardia. In particular atrial flutter may be conducted 1 1 in this relatively young patient population and cause cardiovascular collapse. At the other end of the spectrum it is essential that all high-risk subjects have regular 12-lead EKGs at their clinic visits to detect slow symptom-free atrial flutter. Rather than list the myriad arrhythmias that can be encountered in this population we will focus on the practicalities of treating some of the most common rhythm upsets see Table 23.1 . Atypical flutter intra-atrial re-entry Atypical flutter or intra-atrial re-entry tachycardia IART is worth a special note. This is a common cause of palpitation in those with previous atrial surgery. Prior surgery and atrial stretch are the substrate for the development of multiple clockwise circuits around electrical barriers of suture lines and scarring. These palpitations recur frequently and often necessitate multiple admissions to hospital. Acutely chemical cardioversion is rare and patients often .