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Review
August 19, 2020

Understanding Electrocardiography in Adult Patients With Congenital Heart Disease: A Review

Author Affiliations
  • 1Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
  • 2Pasteur Clinic, Toulouse, France
  • 3Hôpital Marie Lannelongue, Le Plessis-Robinson, France
  • 4Sydney Medical School, Sydney, New South Wales, Australia
  • 5Royal Brompton Hospital, London, United Kingdom
  • 6Montreal Heart Institute, Montreal, Quebec, Canada
  • 7Adult Congenital Heart Disease Unit, Department of Cardiology, European Georges Pompidou Hospital, Paris, France
JAMA Cardiol. 2020;5(12):1435-1444. doi:10.1001/jamacardio.2020.3416
Abstract

Importance  Congenital heart disease in adults is still a relatively new concept for many cardiologists, and the complexity as well as diversity of cardiac phenotypes encountered necessitate that systematic, practical information be available for the nonspecialist. The analysis of the 12-lead electrocardiogram is an invaluable cornerstone in the clinical appraisal of these patients.

Observations  Consideration of the main anatomic and pathophysiological aspects of the various congenital heart conditions can shed light on their distinctive electrocardiogram patterns, which are an electrical reflection of intrinsic cardiac anatomy abnormalities, surgical scarring, and progressive cardiac remodeling attributable to hemodynamic perturbations. While congenital heart disease may be diagnosed or suspected on electrocardiogram observation in adults who are previously undiagnosed, specific markers have also been identified to optimize risk stratification in certain defects.

Conclusions and Relevance  This review outlines that main electrocardiogram patterns in adult patients with congenital heart disease can be appreciated by the understanding of the underlying pathophysiology. Periodic surveillance is of particular importance in this population to unmask early electric signs of disease evolution.

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