Hi, my name is Daniel Cortez. I'm one of the pediatric and adult congenital electrophysiologists over at the University of Minnesota. Today I'm going to be talking about arrhythmia prediction in patients with adult congenital heart disease, primarily non-invasive ways. So to start with the scope of the problem, the prevalence of arrhythmias in adults with congenital heart disease is very high, including a high risk of ventricular arrhythmias in tetralogy for low patients, a high risk of atrial arrhythmias in transposition of the great artery patients with some ventricular arrhythmias, as well as high incidence of things like atrial fibrillation or other atrial arrhythmias in patients with ASDs, whether they're secundum or primum repairs, and primarily in the 6th and 7th decade of life with atrial fibrillation and also increased risk of stroke. Fontan patients have a very high risk of atrial arrhythmias, particularly intraatrial re-injection tachycardia, as well as atypical and typical flutter, typically also presenting in the 3rd and 4th decades of life. The most well-studied group is tetralogy of Fallot for ventricular tachycardia risk and time and time again, prior palliative shunt as well as type of repair have been found to be significantly predictive. Curest duration of 180 milliseconds is also a significant finding, however there are patients with VT or sudden death that have a curest duration of less than 180. Atrial arrhythmias is also a predictive factor as well as increased right ventricular size and depressed ejection fraction as well as increased left ventricular size and depressed ejection fraction are predictive of ventricular tachycardia. For atrial arrhythmias in congenital heart disease patients, right AV valve regurgitation and pulmonary hypertension have also time and time again been shown to be significant. Another way of looking at this is to look at something called vector cardiography, which is looking at the X, Y, and Z axis of the EKG. So getting a superior, posterior, leftward, inferior, anterior, and rightward direction to look at things like the P wave vector magnitude or how far the P wave deviates in three-dimensional space, the QRS vector magnitude, the T wave vector magnitude, or an angle between these measures of deviation called the spatial QRST angle, which is the measure of depolarization to repolarization difference. Patients with tetralogy of Fallot looking at a QRS vector magnitude that was shown to demonstrate that a lower QRS vector magnitude was associated with ventricular arrhythmia risk. Also patients with Fontan palliation had a higher spatial QRST angle when they had ventricular arrhythmias and thus a spatial QRST angle of 103 degrees or higher did predict development of ventricular tachycardia. There, of course, are other noninvasive measures that we should all be assessing and I think we will continue to learn more as time goes on. Thank you very much.

arrhythmia prediction

ventricular arrhythmias

atrial arrhythmias

risk factors

vector cardiography