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Advances in Motion

The challenge of treating supraventricular arrhythmias

Journal

Originally published on Heart

Key findings

  • Although improvements in medical care and surgical techniques have reduced mortality rates among adults with congenital heart disease (ACHD), treating patients with supraventricular (SVT) arrhythmias remains a major challenge
  • One of the reasons for this is the difficulty in collecting evidence for developing guidelines
  • Randomized controlled trials (RCTs) provide sufficient data for developing guidelines, but due to heterogeneity of diagnoses and physiological variations, ACHD populations participate in a small number of RCTs
  • Data mined from electronic medical records can be used to help in interpreting randomized and observational trials as well as informing guidelines

Although improvements in medical care and surgical techniques have reduced mortality rates among adults with congenital heart disease (ACHD), treating patients with supraventricular (SVT) arrhythmias remains a major challenge.

One of the reasons for this is the difficulty in collecting evidence for developing guidelines, per a commentary by two Massachusetts General Hospital experts in the journal Heart.

Improving treatment for patients with SVT is critical, according to the review, with up to 50% of ACHD patients developing SVT. While life expectancy for ACHD patients has improved greatly, living longer leaves the door open for other complications to develop. Arrhythmias are the leading cause of hospitalization in this population, and SVT can lead to worse heart failure and an increased risk for stroke.

More than 90% of children with CHD in developed countries will survive into adulthood as the ACHD patient population continues to grow. Experts anticipate that this population will require treatment by physicians who are trained in the specifics of this subspecialty.

Patients with ACHD present specific challenges to researchers that other cardiac patients do not. For most other cardiac patients, randomized controlled trials (RCTs) provide sufficient data for developing guidelines. However, due to heterogeneity of diagnoses and physiological variations, ACHD populations participate in a small number of RCTs.

While randomized trials are the gold standard for testing potential treatments for other cardiac patients, observational studies and registries are necessary for the ACHD population. Through observational studies and registries, procedural outcomes can be assessed, as well as incidence trends, risk factor interactions and response to therapies.

The American College of Cardiology Improving Pediatric and Adult Congenital Treatment (IMPACT) contains data on 77,000 congenital cardiac catheterizations from more than 90 hospitals and was expanded in 2016 to include electrophysiology procedures. A weakness, however, is that the data only cover outcomes related to the index hospital admission.

To measure lifelong outcomes, a “wealth of data” exists to be mined from electronic medical records. The data can be used to help in interpreting randomized and observational trials as well as informing guidelines.

Critical for the ACHD population is increased participation in studies and registries. ACHD patients can make ACHD-specific contributions, because they are often younger than other trial participants and are comfortable with the mobile technology used to upload data.

90%
 of children with congenital heart disease will grow into adulthood

50%
 of adults with CHD will develop supraventricular arrhythmias

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