Patient-activated Antitachycardia Pacing in Adult Congenital Heart Disease

Abstract

Background: Intra-atrial reentrant tachycardia (IART) is a common arrhythmia in adult congenital heart disease (ACHD) that causes significant morbidity and mortality. Treatments for IART (medical therapy, transcatheter or surgical ablation) have limited success. Antitachycardia pacing (ATP) has been shown to be a safe and effective alternative therapy. ATP algorithms deliver overdrive pacing for IART with 2:1 conduction, but the algorithm will not recognize IART with 1:1 conduction. Temporary Patient Activated Rx (TPARx) is Medtronic software that can be installed in antitachycardia pacemakers allowing patients to deliver ATP on demand. When TPARx is activated by the patient, the pacemaker will recognize and treat IART with 1:1 conduction. Objective: Describe long-term use of patient-activated ATP for IART in ACHD patients. Methods: Retrospective chart review. Results: Three ACHD patients with recurrent IART underwent Fontan conversion, arrhythmia surgery, and placement of an epicardial dual-chamber antitachycardia pacemaker. They had recurrent IART with 1:1 conduction that failed to trigger ATP therapies, resulting in frequent hospital admissions. TPARx software was programmed into their pacemakers to allow recognition and treatment of IART with 1:1 conduction. Mean follow-up duration after TPARx programming was 69 months. Each patient received numerous ATP therapies via TPARx – mean 3 to 26 ATP/year (Table 1). Conclusion: This series demonstrates that TPARx software is a safe, effective long-term management strategy in select ACHD patients with IART who have failed more conventional therapies.