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.

Cardiovascular Division Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USA

Children's Heart Centre 2nd Faculty of Medicine Charles University Prague and Motol University Hospital Prague Czech Republic

Department of Cardiology Heart Center Amsterdam University Medical Centers University of Amsterdam Amsterdam the Netherlands

Department of Cardiology Royal Brompton and Harefield Hospital Royal Brompton and Harefield NHS Trust Imperial College London London United Kingdom

Department of Cardiovascular Medicine Mayo Clinic College of Medicine Rochester Minnesota USA; Department of Medicine Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia

Department of Internal Medicine and Pediatrics Johns Hopkins University Baltimore Maryland USA

Division of Cardiology Department of Medicine University of California Los Angeles Medical Center Ahmanson UCLA Adult Congenital Heart Disease Center Los Angeles California USA; UCLA Cardiac Arrhythmia Center UCLA Health System David Geffen School of Medicine at UCLA Los Angeles California USA; Division of Cardiology Department of Pediatrics UCLA Medical Center Los Angeles California USA

Division of Cardiology Inova Children's Hospital Fairfax Virginia USA

Division of Cardiology Peter Munk Cardiac Centre University Health Network and University of Toronto Toronto Ontario Canada

Division of Cardiovascular Surgery Departments of Surgery and Pediatrics University of Florida Gainesville Florida USA

Division of Pediatric Cardiology and Pediatric Critical Care Medicine Department of Pediatrics Icahn School of Medicine at Mount Sinai and Kravis Children's Hospital at Mount Sinai Mount Sinai Medical Center New York New York USA

Division of Pediatric Cardiology Department of Pediatrics Stanford University Stanford California USA

Freeman Hospital Cardiothoracic Centre Newcastle upon Tyne Tyne and Wear United Kingdom

McGill Adult Unit for Congenital Heart Disease Excellence Division of Cardiology McGill University Montreal Quebec Canada

Montreal Heart Institute Université de Montréal Montreal Quebec Canada

Mount Sinai Adult Congenital Heart Disease Center Mount Sinai Cardiovascular Institute and The Children's Heart Center Mount Sinai Kravis Children's Hospital New York New York USA

Vanderbilt University Medical Center Nashville Tennessee USA

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