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

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.