Repaired complete atrioventricular septal defect patient with late bradyarrhythmia: Case presentation by Matthias Greutmann, MD, FESC

1. Periodic (?annual) rhythm monitoring with Holter or other monitors should be considered part of the management regimen in patients with complex ACHD. 2. In patients with intellectual or psychiatric issues which confound management, placement of an implantable loop recorder can give long-term information about rhythm derangements. 3. Tachyarrhythmia therapy does not prevent the development of late bradyarrhythmias. Indeed, tachyarrhythmia therapy with medications can exacerbate bradyarrhythmia issues. 4. There is no role for “prophylactic” CRT in patients with biventricular hearts without systemic ventricular dysfunction. However, if such a patient undergoes placement of a ventricular or dual chamber pacemaker and subsequently develops ventricular dysfunction, dyssynchrony from pacing should be considered the likely cause of the ventricular dysfunction and upgrade to CRT device should be instituted.