Author + information
- Christophe P. Teuwen, MD and
- Natasja M.S. de Groot, MD, PhD∗ ()
- ↵∗Translational Electrophysiology, Department of Cardiology, Erasmus Medical Center, PO Box 616, ‘s-Gravendijkwal 230, 3015CE Rotterdam, the Netherlands
We have read with interest the recent paper by Labombarda et al. (1), which describes the development of different types of atrial tachyarrhythmias (ATs) in patients with congenital heart disease (CHD). Although previous studies reported that regular ATs are an increasing health burden in patients with CHD, the current study showed that atrial fibrillation (AF) might be the next major health issue in the aging CHD population. Their observation is in line with our report on AF development in 199 patients with CHD, in whom AF developed at a relatively young age of 49 years (2). We also reported frequent co-existence of regular AT and AF (Figure 1) and rapid progression from paroxysmal to (long-standing) persistent and/or permanent AF.
In the current study, the investigators included a considerable number of patients (37.3%) who received pacemaker therapy. Unfortunately, information on pacemaker indications, type of pacemaker (single- or dual-chamber pacemakers), and usage of antitachycardia therapy were not provided. In our opinion, it would be of interest to investigate the impact of atrial pacing on development and progression of AF because it has been suggested that pacing of atrial tissue influences development of AT (3). It should also be taken into account that pacemakers and implantable cardioverter-defibrillators continuously monitor cardiac rhythm, which increases the chance of detecting asymptomatic episodes of AT. Hence, the observed incidences of AT might be higher than the incidences reported in patients without implantable devices.
Intra-atrial reentry tachycardia (IART) and focal AT were differentiated from each other using the surface electrocardiogram only. However, previous studies demonstrated discrepancies between diagnoses made using surface electrocardiograms and endovascular electroanatomical mapping studies. For example, ectopic AT in the presence of large areas of conduction delay can produce a surface electrocardiogram resembling an IART (4). Because in the present study invasive electrophysiological studies were not performed in all patients, grouping of all different regular AT seems appropriate. In future studies, it would be of interest to investigate differences in the time course of AF for each of these different types of regular AT.
Altogether, Labombarda et al. (1) conducted an interesting study supporting our initial findings on AF in CHD patients, and we expect more reports that focus on this important health issue will follow in the future.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
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