Management of Supraventricular Arrhythmias in Congenital Heart Disease

Supraventricular arrhythmias in patients with congenital heart disease represent a complex interplay between structural anomalies, surgical repair techniques and the intrinsic electrophysiological substrate. These rhythms range from paroxysmal atrial tachycardia to atrioventricular nodal re‐entrant tachycardia and junctional ectopic tachycardia, each carrying risks of haemodynamic compromise, thromboembolism and sudden cardiac death. Management demands a tailored approach that balances pharmacological therapy, catheter‐based interventions and surgical modifications. Initial assessment utilises non‐invasive monitoring and electrocardiography to characterise the arrhythmia mechanism, burden and triggers. Medical therapy employs rate‐ or rhythm‐control strategies, with β‐blockers, calcium‐channel blockers, digoxin and novel agents selected according to age, anatomy and comorbidities. Catheter ablation, guided by three‐dimensional mapping and intracardiac recordings, offers definitive cure in many, but carries unique challenges in complex anatomy or prior surgical repairs. In the postoperative setting, close surveillance for early junctional ectopic tachycardia and other transient arrhythmias informs prompt intervention, including electrolyte optimisation and pacing protocols. A multidisciplinary team, comprising electrophysiologists, cardiothoracic surgeons and specialised nurses, is essential to integrate risk stratification, patient education and long‐term follow‐up, thereby improving quality of life and survival in this growing population.

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Management of Supraventricular Arrhythmias in Congenital Heart Disease publication trend

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Technical terms

Supraventricular arrhythmia: An abnormal rapid heart rhythm originating above the ventricles, often involving atrial tissue or the atrioventricular node.

Junctional ectopic tachycardia: A rapid rhythm arising from enhanced automaticity in the atrioventricular junction, common after paediatric heart surgery.

Catheter ablation: A minimally invasive procedure that uses targeted energy to eliminate small areas of aberrant electrical conduction causing arrhythmia.

Holter monitoring: Continuous ambulatory recording of the electrocardiogram, typically over 24–72 hours, to detect transient or paroxysmal arrhythmias.

Antiarrhythmic medication: Drugs used to suppress or prevent abnormal heart rhythms, classified by their primary effect on cardiac ion channels or conduction pathways.

References

1. Prevalence of and risk factors for perioperative arrhythmias in neonates and children after cardiopulmonary bypass: continuous holter monitoring before and for three days after surgery. Journal of Cardiothoracic Surgery (2010).
2. Junctional ectopic tachycardia in infants and children. Journal of Arrhythmia (2019).
3. Antiarrhythmic Medication in Neonates and Infants with Supraventricular Tachycardia. Pediatric Cardiology (2022).