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(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.

	Introduction

 
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:   Table. Typical ECG Features in Common Forms of ACHD

	Anatomy of the Conduction System in ACHD

 
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 . . . [Full Text of this Article]