Unrepaired primum atrial septal defect with atrial fibrillation and broad complex tachycardia: Submitted by J.P. Bokma, MD, PhD

Seshadri Balaji, Ravi Mandapati, Gary D. Webb

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

1. In patients with ACHD with AFib consider the possibility that IART can mimic AFib because of low-amplitude subtle P waves. 2. Patients with ACHD with AFib or IART should be aggressively managed from both the rhythm and the thromboembolic perspectives. 3. Rhythm treatment acutely involves cardioversion (electrical vs. chemical) and long-term treatment with drugs or ablation. 4. Thromboembolic risk mitigation is generally with Coumadin, although the newer anticoagulants may be appropriate in some cases. 5. Before placement of an intracardiac endocardial device (pacemaker or ICD) an evaluation for intracardiac shunts is mandatory. 6. If an intracardiac shunt is present, the epicardial approach (or an SICD) may be the better option. 7. If those are deemed too risky or unattractive, endocardial approach with aggressive anticoagulation may be considered as a last-ditch option.

Original languageEnglish (US)
Title of host publicationArrhythmias in Adult Congenital Heart Disease
Subtitle of host publicationA Case-Based Approach
PublisherElsevier
Pages29-37
Number of pages9
ISBN (Electronic)9780323485685
ISBN (Print)9780323496094
DOIs
StatePublished - Jan 1 2018

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Atrial septal defect
  • Subcutaneous defibrillator
  • Thromboembolism
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Medicine(all)

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