Refer CHD patients with documented arrhythmias or at high risk for postprocedural arrhythmias (eg, atrial septal defect [ASD] closure at older age) considered for percutaneous or surgical (re)interventions to a center with a multidisciplinary team with expertise in these interventions and in invasive treatment of arrhythmias.
In mild CHD, the ESC recommends catheter ablation over long-term medical therapy for symptomatic, sustained recurrent supraventricular tachycardia (SVT) (atrioventricular node reentrant tachycardia [AVNRT], atrioventricular reentrant tachycardia [AVRT], atrial tachycardia [AT], and intraatrial reentrant tachycardia [IART]), or if SVT is potentially related to sudden cardiac death (SCD).
Catheter ablation is indicated as adjunctive therapy to implantable cardioverter defibrillators (ICDs) in those who have recurrent monomorphic ventricular tachycardia (VT), incessant VT, or electrical storm refractory to medical therapy or ICD reprogramming.
ICD implantation is indicated in adults with CHD who have:
- Survived an aborted cardiac arrest due to ventricular fibrillation (VF) or hemodynamically untolerated VT after evaluation to define the event etiology and exclude reversible causes
- Sustained VT after hemodynamic evaluation and repair when indicated
Electrophysiologic (EP) evaluation is required to identify those in whom catheter or surgical ablation may be a beneficial adjunctive therapy or may offer a reasonable alternative.