Arrhythmias in adults with congenital heart disease and heart failure
Arrhythmias and heart failure are among the most common complications encountered by adults with congenital heart disease (CHD). In this contemporary review, we explore the interactions between arrhythmias and heart failure and discuss management strategies. Major knowledge gaps are highlighted thro...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | Heart Rhythm O2 |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501821002026 |
| _version_ | 1819095352723111936 |
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| author | Francis Bessière, MD, PhD Blandine Mondésert, MD Marie-A Chaix, MD, MSc Paul Khairy, MD, PhD |
| author_facet | Francis Bessière, MD, PhD Blandine Mondésert, MD Marie-A Chaix, MD, MSc Paul Khairy, MD, PhD |
| author_sort | Francis Bessière, MD, PhD |
| collection | DOAJ |
| description | Arrhythmias and heart failure are among the most common complications encountered by adults with congenital heart disease (CHD). In this contemporary review, we explore the interactions between arrhythmias and heart failure and discuss management strategies. Major knowledge gaps are highlighted throughout. Interactions between arrhythmias and heart failure are complex and bidirectional, with one begetting the other. Arrhythmias can provoke heart failure through various mechanisms: conduction disturbances may contribute to inefficient ventricular filling and contraction patterns; bradyarrhythmias and tachyarrhythmias can result in a reduction in cardiac output; hypoxemia may be exacerbated by right-to-left shunting; and tachycardia-induced cardiomyopathy has potentially devastating consequences if the diagnosis is delayed. In turn, heart failure promotes arrhythmogenesis through various structural (eg, fibrosis, chamber dilation, hypertrophy) and electrical remodeling effects that include changes to ion currents and channels and connexin expression, along with shortening of atrial and ventricular refractory periods with increased heterogeneity. Several shared comorbidities can contribute to, and modulate the impact of, arrhythmias and heart failure. Preemptive arrhythmia management can potentially mitigate effects on heart failure exacerbations. Similarly, optimal heart failure control could curtail its impact on arrhythmogenesis. Treatment strategies to prevent or treat heart failure in adults with CHD encompass pharmacological agents, catheter ablation, and device therapies including defibrillators, cardiac resynchronization therapy, and His bundle pacing. High-priority research avenues with major knowledge gaps include tachycardia-induced cardiomyopathy, catheter ablation of atrial fibrillation, defibrillator indications in high-risk subsets, and the role of cardiac resynchronization therapy and His bundle pacing in diverse forms of CHD. |
| first_indexed | 2024-12-21T23:41:56Z |
| format | Article |
| id | doaj.art-dab3667f220a45dd92870b4305b89b54 |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-12-21T23:41:56Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-dab3667f220a45dd92870b4305b89b542022-12-21T18:46:12ZengElsevierHeart Rhythm O22666-50182021-12-0126744753Arrhythmias in adults with congenital heart disease and heart failureFrancis Bessière, MD, PhD0Blandine Mondésert, MD1Marie-A Chaix, MD, MSc2Paul Khairy, MD, PhD3Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Lyon, FranceMontreal Heart Institute, Université de Montréal, Montreal, CanadaMontreal Heart Institute, Université de Montréal, Montreal, CanadaMontreal Heart Institute, Université de Montréal, Montreal, Canada; Address reprint requests and correspondence: Dr Paul Khairy, Montreal Heart Institute, 5000 Belanger St E., Montreal, QC, Canada, H1T 1C8.Arrhythmias and heart failure are among the most common complications encountered by adults with congenital heart disease (CHD). In this contemporary review, we explore the interactions between arrhythmias and heart failure and discuss management strategies. Major knowledge gaps are highlighted throughout. Interactions between arrhythmias and heart failure are complex and bidirectional, with one begetting the other. Arrhythmias can provoke heart failure through various mechanisms: conduction disturbances may contribute to inefficient ventricular filling and contraction patterns; bradyarrhythmias and tachyarrhythmias can result in a reduction in cardiac output; hypoxemia may be exacerbated by right-to-left shunting; and tachycardia-induced cardiomyopathy has potentially devastating consequences if the diagnosis is delayed. In turn, heart failure promotes arrhythmogenesis through various structural (eg, fibrosis, chamber dilation, hypertrophy) and electrical remodeling effects that include changes to ion currents and channels and connexin expression, along with shortening of atrial and ventricular refractory periods with increased heterogeneity. Several shared comorbidities can contribute to, and modulate the impact of, arrhythmias and heart failure. Preemptive arrhythmia management can potentially mitigate effects on heart failure exacerbations. Similarly, optimal heart failure control could curtail its impact on arrhythmogenesis. Treatment strategies to prevent or treat heart failure in adults with CHD encompass pharmacological agents, catheter ablation, and device therapies including defibrillators, cardiac resynchronization therapy, and His bundle pacing. High-priority research avenues with major knowledge gaps include tachycardia-induced cardiomyopathy, catheter ablation of atrial fibrillation, defibrillator indications in high-risk subsets, and the role of cardiac resynchronization therapy and His bundle pacing in diverse forms of CHD.http://www.sciencedirect.com/science/article/pii/S2666501821002026ArrhythmiasCatheter ablationCardiac resynchronization therapyCongenital heart diseaseHeart failureHis bundle pacing |
| spellingShingle | Francis Bessière, MD, PhD Blandine Mondésert, MD Marie-A Chaix, MD, MSc Paul Khairy, MD, PhD Arrhythmias in adults with congenital heart disease and heart failure Heart Rhythm O2 Arrhythmias Catheter ablation Cardiac resynchronization therapy Congenital heart disease Heart failure His bundle pacing |
| title | Arrhythmias in adults with congenital heart disease and heart failure |
| title_full | Arrhythmias in adults with congenital heart disease and heart failure |
| title_fullStr | Arrhythmias in adults with congenital heart disease and heart failure |
| title_full_unstemmed | Arrhythmias in adults with congenital heart disease and heart failure |
| title_short | Arrhythmias in adults with congenital heart disease and heart failure |
| title_sort | arrhythmias in adults with congenital heart disease and heart failure |
| topic | Arrhythmias Catheter ablation Cardiac resynchronization therapy Congenital heart disease Heart failure His bundle pacing |
| url | http://www.sciencedirect.com/science/article/pii/S2666501821002026 |
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