ATrial Tachycardia PAcing Therapy in Congenital Heart
ATrial Tachycardia PAcing Therapy in Congenital Heart
Congenital heart disease (CHD) affects approximately 1% of newborns in the US, with 25% of
 those affected having critical conditions requiring open heart surgery within one year of
 birth. Surgical and medical advances have allowed many patients to live beyond their fourth
 and fifth decades of life. Unfortunately, cardiac arrhythmias are a relatively common sequela
 due to cardiac anomalies and surgical scars in addition to residual volume and pressure load
 on the heart. Atrial arrhythmias, including sinus node dysfunction and intra-atrial
 re-entrant tachycardia (IART) are among the more common abnormalities found in adults with
 repaired CHD. The presence of IART significantly increases morbidity and mortality, and
 anti-arrhythmic medications have been shown to be a sub-optimal treatment strategy with the
 majority of patients requiring multi-drug therapy. Catheter ablation procedures remain a
 treatment option, but are less successful for some patient demographics. In the mid-1990's,
 pacemakers with atrial anti-tachycardia pacing (ATP) capabilities were developed, primarily
 for the management of atrial flutter and fibrillation in adults with structurally normal
 hearts. Given the need for pacemakers in the CHD population to manage sinus node dysfunction
 and atrioventricular node conduction block, the adoption of atrial anti-tachycardia
 pacemakers began to gain favor. However, there is limited data available comparing the safety
 and effectiveness of ATP therapy between various demographics of CHD patients. In the current
 study, the investigators aim to determine if ATP is an effective treatment strategy for IART,
 specifically within particular sub-populations of CHD patients. Additionally, investigators
 hope to delineate any significant differences in efficacy of ATP treatment between adult and
 pediatric congenital heart patients. The research team will accomplish our goals with a
 retrospective, multi-center study in which data is collected from existing electronic medical
 records and pacemaker interrogations. Following data collection, the investigators will
 employ statistical analyses to determine if certain CHD demographics are statistically
 significant predictors of ATP therapy outcomes.

 The purpose of this prospective/retrospective study is to determine how effective atrial
 anti-tachycardia therapies are with the congenital heart patients who are known to have
 atrial arrhythmias. As this population ages, we know that arrhythmic burden increases and
 medications are increased or changed for symptomatic improvement.

 Patients will be enrolled at the time of anti tachycardia device (ATD) placement or when
 device therapies are turned on. Patients will need a minimum of 5 years of clinical history
 prior to implantation and after implantation (unless patient is very young). Data will be
 collected both retrospectively and prospectively. The research team will consent patients at
 the time of clinical evaluations and scheduled follow-ups (usually 3 - 6 months). If therapy
 is effective, investigators will determine the specific programming which was successful. If
 therapy was ineffective, investigators will also determine if a change in programing was made
 and if this improved ATP efficacy. Investigators will also determine the arrhythmia burden.
 Cardioversion and medications before and after ATD implantation will be the key determinants
 of arrhythmia burden in this study.
University of Iowa is moving to begin the multi-institutional portion of this study by asking
 for centers to assist with enrollment so that the investigators can meet our enrollment goal.
 The investigators wish to recruit a minimum of 250 subjects and will collect data for up to
 300 subjects. The research team will move to a retrospective and prospective enrollment
 looking at how well ATP works in ATD therapy devices for patients who have CHD. No
 interventions will take place as this is a chart review and observational study.
Inclusion Criteria:

 -  must have structural CHD, an atrial arrhythmia and an ATD implanted. ATP must be
 turned on.

 Exclusion Criteria:

 -  Other arrhythmias substrates such as Long QT (LQT), hypertrophic Cardiomyopathy (HCM),
 Catecholaminergic polymorphic ventricular tachycardia (CPVT), Arrhythmogenic Right
 Ventricular Cardiomyopathy.(ARVC), Brugada & patients who undergo transplant, surgical
 maze, or ablation within 5 years of ATD implantation.