Circulation. 2007;116:2734-2746
doi: 10.1161/CIRCULATIONAHA.107.691568
(Circulation. 2007;116:2734-2746.)
© 2007 American Heart Association, Inc.
Contemporary Reviews in Cardiovascular Medicine |
Clinical Use of Electrocardiography in Adults With Congenital Heart Disease
Paul Khairy, MD, PhD;
Ariane J. Marelli, MD
From the Adult Congenital Heart Center and Electrophysiology Service (P.K.), Montreal Heart Institute, University of Montreal, and the McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) (A.J.M.), Montreal, Canada.
Correspondence to Paul Khairy, MD, PhD, Adult Congenital Heart Center, Montreal Heart Institute, 5000 Bélanger St, Montreal, Quebec, Canada H1T 1C8. E-mail paul.khairy@umontreal.ca
Key Words: arrhythmia heart defects, congenital electrocardiography
An extract of the first 250 words of the full text is provided, because this article has no abstract.
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Introduction
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The prevalence of adult congenital heart disease (ACHD) has
risen markedly over the past 2 decades, with the number of adults
now rivaling the number of children with severe defects.
1 This
is, perhaps, not surprising given that current care allows nearly
90% of infants born with heart defects to thrive into their
adult years.
1,2 This remarkable triumph is tempered, however,
by the realization that early interventions were reparative
and not curative. Numerous complications may surface years after
uneventful childhood courses, justifying vigilant clinical follow-up
throughout adulthood. The 12-lead ECG remains an invaluable
cornerstone in the clinical appraisal of adults with congenital
heart disease that, in certain circumstances, provides diagnostic
and/or prognostic information. The present review imparts a
clinical perspective to ECG interpretation in ACHD, emphasizing
practical and pathogenomonic findings in the more frequently
encountered congenital defects in adults. Anatomic features
of the conduction system relevant to ECG findings in ACHD are
summarized, including variations in the location of the sinus
node, atrioventricular (AV) node, and His-Purkinje system. Thereafter,
pertinent ECG features are highlighted for common subtypes of
ACHD (Table). Examples are provided throughout for illustration.
View this table:
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Table. Typical ECG Features in Common Forms of ACHD
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Anatomy of the Conduction System in ACHD
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Sinus Node
In the morphologically normal heart, a crescent-shaped sinus
node is characteristically located epicardially along the lateral
aspect of the superior cavoatrial junction. It generates a P-wave
axis typically between 15° and 75°. Most patients with
ACHD have normally positioned atrial chambers, called atrial
situs solitus, with normal sinus node location. The position
of the
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