A crisscross heart with brady-tachy issues: Case submitted by Vivienne Ezzat, MBChB

Abstract

1. Brady- and tachyarrhythmias frequently coexist in complex ACHD patients. Management of one can complicate management of the other. 2. All ACHD patients with intracardiac shunts and/or sluggish blood flow (e.g., Fontan operation) should be anticoagulated even if asymptomatic. If, in addition, they have tachyarrhythmias, anticoagulation should be started regardless of symptoms. 3. In ACHD patients with intracardiac shunts, endocardial pacing (including the leadless pacemaker) should be avoided. The default method for pacing should be the epicardial approach. 4. Long-term amiodarone should be considered the last option for drug therapy.