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Management
10.8. Adult Congenital Heart Disease (ACHD)
COR LOE
Recommendations
1 B-NR 1. In adults with ACHD and AF, it is recommended to evaluate
for and treat precipitating factors and reversible causes of
AF, recognizing that residual hemodynamic sequalae may
contribute to the occurrence of the arrhythmia.
1 C-LD 2. In adults with AF and moderate or complex congenital
heart disease, electrophysiological procedures should be
performed by operators with expertise in ACHD procedures
and in collaboration with an ACHD cardiologist, ideally in
specialized centers, when available.
1 C-LD 3. In adults with congenital heart disease and symptomatic or
hemodynamically significant paroxysmal or persistent AF, an
initial strategy of rhythm control is recommended regardless of
lesion severity as AF in this population is often poorly tolerated.
2a B-NR 4. In symptomatic patients with simple congenital heart disease
with AAD-refractory AF, it is reasonable to choose ablation
over long-term antiarrhythmic therapies.
2b C-LD 5. In ACHD patients with AF undergoing PVI, it may be
reasonable to include an ablative strateg y in the right atrium
directed at reentrant arrhythmia secondary to atriotomy scars
and the CTI.
2b C-LD 6. In adults with AF and moderate or severe forms of congenital
heart disease, particularly those with low-flow states such
as Fontan circulation, blind-ending cardiac chambers, and
cyanosis, it may be reasonable to treat with anticoagulation
independent of conventional risk score to reduce risk of
thromboembolic events.
10.7. HCM
