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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710623/ https://www.ncbi.nlm.nih.gov/pubmed/34988526 http://dx.doi.org/10.1016/j.hroo.2021.10.005 |
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author | Bessière, Francis Mondésert, Blandine Chaix, Marie-A Khairy, Paul |
author_facet | Bessière, Francis Mondésert, Blandine Chaix, Marie-A Khairy, Paul |
author_sort | Bessière, Francis |
collection | PubMed |
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. |
format | Online Article Text |
id | pubmed-8710623 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-87106232022-01-04 Arrhythmias in adults with congenital heart disease and heart failure Bessière, Francis Mondésert, Blandine Chaix, Marie-A Khairy, Paul Heart Rhythm O2 Arrhythmias in Congenital Heart Disease 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. Elsevier 2021-12-17 /pmc/articles/PMC8710623/ /pubmed/34988526 http://dx.doi.org/10.1016/j.hroo.2021.10.005 Text en © 2021 Heart Rhythm Society. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Arrhythmias in Congenital Heart Disease Bessière, Francis Mondésert, Blandine Chaix, Marie-A Khairy, Paul Arrhythmias in adults with congenital heart disease and heart failure |
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 in Congenital Heart Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710623/ https://www.ncbi.nlm.nih.gov/pubmed/34988526 http://dx.doi.org/10.1016/j.hroo.2021.10.005 |
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