Abstract 10911: Management of First Onset Supraventricular Tachycardias in adults with Congenital Heart Disease
Background Supraventricular tachycardias (SVT) are a major cause of morbidity in adults with congenital heart disease (CHD). Few data exist on the efficacy of anti-arrhythmics in this population. Our aim was to investigate the efficacy of various pharmacological treatments of SVTs.
Methods This was a multicenter retrospective study including adults with CHD and new onset of SVT from January 2008 to January 2011. Patients were identified from a nationwide registry. Data was obtained from medical records.
Results Overall, 9537 patients were included in the registry of whom 7171 had no history of SVT. New onset SVT occurred in 132 of 7171 patients (1.8%). Data collection was completed in 92 patients (mean age 51±16 years, 57% female). SVTs included atrial fibrillation (60%), unspecified SVT (23%), atrial flutter (13%), and atrioventricular nodal reentry tachycardia (4%). The majority of these patients had septal defects (50%) and left sided lesions (21%). The acute management of SVTs were electrical cardioversion (38%), oral drugs (38%) and intravenous drugs (11%) and resulted in sinus rhythm in 90% of patients. Most patients (80%) were instituted on oral anti arrhythmics. After a mean follow-up duration of 2.5±1.4 years, freedom from arrhythmia was present in 21% of patients without anti arrhythmics, 22% of patients on class I, 36% on class II, 67% on class III and 71% on class IV anti arrhythmics (Figure 1). Class III anti-arrhythmics (85% Sotalol, 15% Amiodarone) was associated with a lower risk of recurrence of SVT compared to all other treatment strategies (P=0.033). Side effects of medication occurred in 18 patients (22% class II, 61% class III (all patients with amiodarone), 17% class IV anti arrhythmics).
Conclusion In adults with CHD with first onset of SVT, class III anti-arrhythmic drugs were more efficacious in maintaining sinus rhythm after SVT and should be considered as a first choice therapy. However, side effects of especially amiodarone may limit its use.
- © 2012 by American Heart Association, Inc.