Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 80, Issue 23, Pages 2224-2238Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2022.09.038
Keywords
adults with congenital heart disease; arrhythmia; heart failure
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Heart failure and arrhythmia are the most important cardiovascular diseases among adults with congenital heart disease, and they often overlap and interact with each other. It is crucial for clinical management to recognize these interactions and have access to the available pharmacologic and interventional resources.
Together, heart failure and arrhythmia represent the most important cardiovascular sources of morbidity and mortality among adults with congenital heart disease (ACHDs). Although traditionally conceptualized as operating within 2 distinct clinical silos, these scenarios frequently coexist within the same individual; consequently the mechanistic, therapeutic, and prognostic overlap between them demands increased recognition. In fact, given the near ubiquity of heart failure and arrhythmia among ACHDs, there is perhaps no other arena within cardiology where this critical intersection is more frequently observed. Optimal care for ACHDs therefore requires a heightened awareness of the relevant interactions as well as the pharmacologic and interventional resources that are increasingly available to the treating cardiologist. This review explores and highlights the overlap between these 2 fields to recommend a parallel, yet interactive, multidisciplinary approach to clinical management. Congenital heart disease categories are broken down into their archetypal subtypes to highlight subtleties of the pathophysiology, evaluation, and therapeutic approach.
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