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.
- Klíčová slova
- adults with congenital heart disease, arrhythmia, heart failure,
- MeSH
- dospělí MeSH
- kardiologie * MeSH
- kardiologové * MeSH
- lidé MeSH
- srdeční arytmie etiologie terapie MeSH
- srdeční selhání * komplikace terapie MeSH
- vrozené srdeční vady * komplikace terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Klíčová slova
- Ambulatory ECG monitoring, Antiarrhythmic drug therapy, Antitachycardia pacing, Arrhythmogenic cardiomyopathy, Asystole, Atrioventricular block, Bradycardia, Brugada syndrome, Cardiac channelopathies, Cardiac transplantation, Cardiomyopathy, Cardiovascular implantable electronic devices, Catecholaminergic polymorphic ventricular tachycardia, Children, Congenital heart disease, Coronary artery compression, ECG, Echocardiography, Endocardial lead, Epicardial lead, Expert consensus statement, Genetic arrhythmias, Heart block, Heart failure, Hypertrophic cardiomyopathy, Implantable cardioverter defibrillator, Insertable cardiac monitor, Lead extraction, Lead removal, Long QT syndrome, Low- and middle-income countries, MR imaging, Neuromuscular disease, PACES, Pacemaker, Pediatrics, Postoperative, Remote monitoring, Shared decision-making, Sick sinus syndrome, Sports and physical activity, Sudden cardiac arrest, Sudden cardiac death, Syncope, Transvenous, Ventricular fibrillation, Ventricular tachycardia,
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- Ambulatory ECG monitoring, Antiarrhythmic drug therapy, Antitachycardia pacing, Arrhythmogenic cardiomyopathy, Asystole, Atrioventricular block, Bradycardia, Brugada syndrome, Cardiac channelopathies, Cardiac transplantation, Cardiomyopathy, Cardiovascular implantable electronic devices, Catecholaminergic polymorphic ventricular tachycardia, Children, Congenital heart disease, Coronary artery compression, ECG, Echocardiography, Endocardial lead, Epicardial lead, Expert consensus statement, Genetic arrhythmias, Heart block, Heart failure, Hypertrophic cardiomyopathy, Implantable cardioverter defibrillator, Insertable cardiac monitor, Lead extraction, Lead removal, Long QT syndrome, Low- and middle-income countries, MR imaging, Neuromuscular disease, PACES, Pacemaker, Pediatrics, Postoperative, Remote monitoring, Shared decision-making, Sick sinus syndrome, Sports and physical activity, Sudden cardiac arrest, Sudden cardiac death, Syncope, Transvenous, Ventricular fibrillation, Ventricular tachycardia,
- MeSH
- defibrilátory implantabilní * MeSH
- dítě MeSH
- elektronika MeSH
- konsensus MeSH
- lidé MeSH
- srdce * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- komentáře MeSH
- práce podpořená grantem MeSH
- směrnice pro lékařskou praxi MeSH
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
- Klíčová slova
- Ambulatory ECG monitoring, Antiarrhythmic drug therapy, Antitachycardia pacing, Arrhythmogenic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, Asystole, Atrioventricular block, Bradycardia, Brugada syndrome, Cardiac channelopathies, Cardiac transplantation, Cardiomyopathy, Cardiovascular implantable electronic devices, Catecholaminergic polymorphic ventricular tachycardia, Children, Congenital heart disease, Coronary artery compression, ECG, Echocardiography, Endocardial lead, Epicardial lead, Expert consensus statement, Genetic arrhythmias, Heart block, Heart failure, Hypertrophic cardiomyopathy, Implantable cardioverter defibrillator, Insertable cardiac monitor, Lead extraction, Lead removal, Long QT syndrome, Low- and middle-income countries, MR imaging, Neuromuscular disease, PACES, Pacemaker, Pediatrics, Postoperative, Remote monitoring, Shared decision-making, Sick sinus syndrome, Sports and physical activity, Sudden cardiac arrest, Sudden cardiac death, Syncope, Transvenous, Ventricular fibrillation, Ventricular tachycardia,
- MeSH
- defibrilátory implantabilní * MeSH
- diagnostické techniky kardiovaskulární * MeSH
- diagnostické zobrazování MeSH
- dítě MeSH
- konsensus MeSH
- lidé MeSH
- odstranění implantátu MeSH
- srdeční elektrofyziologie normy MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Spojené státy americké MeSH
- Klíčová slova
- Ambulatory ECG monitoring, Brugada syndrome, Cardiac channelopathies, Cardiac transplantation, Cardiomyopathy, Cardiovascular implantable electronic devices, Catecholaminergic polymorphic ventricular tachycardia, Children, Congenital heart disease, Coronary artery compression, ECG, Echocardiography, Endocardial lead, Epicardial lead, Expert consensus statement, Genetic arrhythmias, Heart block, Heart failure, Hypertrophic cardiomyopathy, Implantable cardioverter defibrillator, Insertable cardiac monitor, Lead extraction, Lead removal, Long QT syndrome, Low- and middle-income countries, MR imaging, Neuromuscular disease, PACES, Pacemaker, Pediatrics, Postoperative, Remote monitoring, Shared decision-making, Sick sinus syndrome, Sports and physical activity, Sudden cardiac arrest, Sudden cardiac death, Syncope, Transvenous, Ventricular fibrillation, Ventricular tachycardia, antiarrhythmic drug therapy, antitachycardia pacing, arrhythmogenic cardiomyopathy, asystole, atrioventricular block, bradycardia,
- MeSH
- defibrilátory implantabilní * MeSH
- dítě MeSH
- elektronika MeSH
- komorová tachykardie * MeSH
- lidé MeSH
- náhlá srdeční smrt MeSH
- srdce MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
- Klíčová slova
- Bradycardia, Brugada syndrome, ECG, Long QT syndrome, MR imaging, PACES, ambulatory ECG monitoring, antiarrhythmic drug therapy, antitachycardia pacing, arrhythmogenic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, asystole, atrioventricular block, cardiac channelopathies, cardiac transplantation, cardiomyopathy, cardiovascular implantable electronic devices, catecholaminergic polymorphic ventricular tachycardia, children, congenital heart disease, coronary artery compression, echocardiography, endocardial lead, epicardial lead, expert consensus statement, genetic arrhythmias, heart block, heart failure, hypertrophic cardiomyopathy, implantable cardioverter defibrillator, insertable cardiac monitor, lead extraction, lead removal, low- and middle-income countries, neuromuscular disease, pacemaker, pediatrics, postoperative, remote monitoring, shared decision-making, sick sinus syndrome, sports and physical activity, sudden cardiac arrest, sudden cardiac death, syncope, transvenous, ventricular fibrillation, ventricular tachycardia,
- MeSH
- Americká kardiologická asociace MeSH
- defibrilátory implantabilní * MeSH
- dítě MeSH
- elektronika MeSH
- kardiologie * MeSH
- konsensus MeSH
- lidé MeSH
- srdeční elektrofyziologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Spojené státy americké MeSH
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
- Klíčová slova
- Ambulatory ECG monitoring, Antiarrhythmic drug therapy, Antitachycardia pacing, Arrhythmogenic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, Asystole, Atrioventricular block, Bradycardia, Brugada syndrome, Cardiac channelopathies, Cardiac transplantation, Cardiomyopathy, Cardiovascular implantable electronic devices, Catecholaminergic polymorphic ventricular tachycardia, Children, Congenital heart disease, Coronary artery compression, ECG, Echocardiography, Endocardial lead, Epicardial lead, Expert consensus statement, Genetic arrhythmias, Heart block, Heart failure, Hypertrophic cardiomyopathy, Implantable cardioverter defibrillator, Insertable cardiac monitor, Lead extraction, Lead removal, Long QT syndrome, Low- and middle-income countries, MR imaging, Neuromuscular disease, PACES, Pacemaker, Pediatrics, Postoperative, Remote monitoring, Shared decision-making, Sick sinus syndrome, Sports and physical activity, Sudden cardiac arrest, Sudden cardiac death, Syncope, Transvenous, Ventricular fibrillation, Ventricular tachycardia,
- MeSH
- Americká kardiologická asociace MeSH
- defibrilátory implantabilní * MeSH
- dítě MeSH
- dospělí MeSH
- elektronika MeSH
- kardiologie * MeSH
- lidé MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Latinská Amerika MeSH
- Spojené státy americké MeSH
Guidelines for the implantation of cardiac implantable electronic devices (CIEDs) have evolved since publication of the initial ACC/AHA pacemaker guidelines in 1984 [1]. CIEDs have evolved to include novel forms of cardiac pacing, the development of implantable cardioverter defibrillators (ICDs) and the introduction of devices for long term monitoring of heart rhythm and other physiologic parameters. In view of the increasing complexity of both devices and patients, practice guidelines, by necessity, have become increasingly specific. In 2018, the ACC/AHA/HRS published Guidelines on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay [2], which were specific recommendations for patients >18 years of age. This age-specific threshold was established in view of the differing indications for CIEDs in young patients as well as size-specific technology factors. Therefore, the following document was developed to update and further delineate indications for the use and management of CIEDs in pediatric patients, defined as ≤21 years of age, with recognition that there is often overlap in the care of patents between 18 and 21 years of age. This document is an abbreviated expert consensus statement (ECS) intended to focus primarily on the indications for CIEDs in the setting of specific disease/diagnostic categories. This document will also provide guidance regarding the management of lead systems and follow-up evaluation for pediatric patients with CIEDs. The recommendations are presented in an abbreviated modular format, with each section including the complete table of recommendations along with a brief synopsis of supportive text and select references to provide some context for the recommendations. This document is not intended to provide an exhaustive discussion of the basis for each of the recommendations, which are further addressed in the comprehensive PACES-CIED document [3], with further data easily accessible in electronic searches or textbooks.
- Klíčová slova
- Ambulatory ECG monitoring, Antiarrhythmic drug therapy, Antitachycardia pacing, Arrhythmogenic cardiomyopathy, Asystole, Atrioventricular block, Bradycardia, Brugada syndrome, Cardiac channelopathies, Cardiac transplantation, Cardiomyopathy, Cardiovascular implantable electronic devices, Catecholaminergic polymorphic ventricular tachycardia, Children, Congenital heart disease, Coronary artery compression, ECG, Echocardiography, Endocardial lead, Epicardial lead, Expert consensus statement, Genetic arrhythmias, Heart block, Heart failure, Hypertrophic cardiomyopathy, Implantable cardioverter defibrillator, Insertable cardiac monitor, Lead extraction, Lead removal, Long QT syndrome, Low- and middle-income countries, MR imaging, Neuromuscular disease, PACES, Pacemaker, Pediatrics, Postoperative, Remote monitoring, Shared decision-making, Sick sinus syndrome, Sports and physical activity, Sudden cardiac arrest, Sudden cardiac death, Syncope, Transvenous, Ventricular fibrillation, Ventricular tachycardia,
- Publikační typ
- časopisecké články MeSH
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
- Klíčová slova
- Ambulatory ECG monitoring, Antiarrhythmic drug therapy, Antitachycardia pacing, Arrhythmogenic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, Asystole, Atrioventricular block, Bradycardia, Brugada syndrome, Cardiac channelopathies, Cardiac transplantation, Cardiomyopathy, Cardiovascular implantable electronic devices, Catecholaminergic polymorphic ventricular tachycardia, Children, Congenital heart disease, Coronary artery compression, ECG, Echocardiography, Endocardial lead, Epicardial lead, Expert consensus statement, Genetic arrhythmias, Heart block, Heart failure, Hypertrophic cardiomyopathy, Implantable cardioverter defibrillator, Insertable cardiac monitor, Lead extraction, Lead removal, Long QT syndrome, Low- and middle-income countries, MR imaging, Neuromuscular disease, PACES, Pacemaker, Pediatrics, Postoperative, Remote monitoring, Shared decision-making, Sick sinus syndrome, Sports and physical activity, Sudden cardiac arrest, Sudden cardiac death, Syncope, Transvenous, Ventricular fibrillation, Ventricular tachycardia,
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Abrupt loss of ventricular preexcitation on noninvasive evaluation, or nonpersistent preexcitation, in Wolff-Parkinson-White syndrome (WPW) is thought to indicate a low risk of life-threatening events. OBJECTIVE: The purpose of this study was to compare accessory pathway (AP) characteristics and occurrences of sudden cardiac arrest (SCA) and rapidly conducted preexcited atrial fibrillation (RC-AF) in patients with nonpersistent and persistent preexcitation. METHODS: Patients 21 years or younger with WPW and invasive electrophysiology study (EPS) data, SCA, or RC-AF were identified from multicenter databases. Nonpersistent preexcitation was defined as absence/sudden loss of preexcitation on electrocardiogram, Holter monitoring, or exercise stress test. RC-AF was defined as clinical preexcited atrial fibrillation with shortest preexcited R-R interval (SPERRI) ≤ 250 ms. AP effective refractory period (APERP), SPERRI at EPS , and shortest preexcited paced cycle length (SPPCL) were collected. High-risk APs were defined as APERP, SPERRI, or SPPCL ≤ 250 ms. RESULTS: Of 1589 patients, 244 (15%) had nonpersistent preexcitation and 1345 (85%) had persistent preexcitation. There were no differences in sex (58% vs 60% male; P=.49) or age (13.3±3.6 years vs 13.1±3.9 years; P=.43) between groups. Although APERP (344±76 ms vs 312±61 ms; P<.001) and SPPCL (394±123 ms vs 317±82 ms; P<.001) were longer in nonpersistent vs persistent preexcitation, there was no difference in SPERRI at EPS (331±71 ms vs 316±73 ms; P=.15). Nonpersistent preexcitation was associated with fewer high-risk APs (13% vs 23%; P<.001) than persistent preexcitation. Of 61 patients with SCA or RC-AF, 6 (10%) had nonpersistent preexcitation (3 SCA, 3 RC-AF). CONCLUSION: Nonpersistent preexcitation was associated with fewer high-risk APs, though it did not exclude the risk of SCA or RC-AF in children with WPW.
- Klíčová slova
- Children, Exercise testing, Life-threatening event, Noninvasive evaluation, Pediatric, Pediatric and Congenital Electrophysiology Society (PACES), Wolff-Parkinson-White syndrome,
- MeSH
- celosvětové zdraví MeSH
- elektrokardiografie ambulantní metody MeSH
- hodnocení rizik metody MeSH
- incidence MeSH
- lidé MeSH
- míra přežití trendy MeSH
- mladiství MeSH
- náhlá srdeční smrt epidemiologie etiologie MeSH
- následné studie MeSH
- převodní systém srdeční patofyziologie MeSH
- retrospektivní studie MeSH
- Wolffův-Parkinsonův-Whiteův syndrom komplikace patofyziologie MeSH
- zátěžový test MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
