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Kawada S, Chakraborty P, Kakarla J, Nanthakumar J, Mondésert B, Khairy P, Nair K. Role of subpulmonary right ventricle in sudden cardiac death in adults with congenital heart disease. Heart Rhythm 2024:S1547-5271(24)03127-8. [PMID: 39127230 DOI: 10.1016/j.hrthm.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Despite improved childhood survival of congenital heart disease (CHD) as a result of advances in management, late-onset sudden cardiac death (SCD) from malignant ventricular arrhythmias remains a leading cause of mortality in adults with CHD. Preventing SCD in these patients requires an understanding of the underlying pathophysiological mechanisms. Many CHD patients experience significant hemodynamic stress on the subpulmonary right ventricle (RV), leading to pathologic remodeling. Unlike acquired heart disease in which left ventricular pathology is prevalent, RV pathologies are crucial in the SCD pathogenesis in CHD patients. This review examines the mechanisms and management of SCD related to subpulmonary RV pathologies in CHD patients.
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Affiliation(s)
- Satoshi Kawada
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada
| | - Praloy Chakraborty
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada
| | - Jayant Kakarla
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada
| | - Jared Nanthakumar
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada; Michael De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Disease Centre, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Adult Congenital Heart Disease Centre, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Krishnakumar Nair
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network Toronto, and University of Toronto, Toronto, Ontario, Canada.
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Habib E, Srivasthan K, El Masry H. Evaluation and Management of Sudden Death Risk in Repaired Tetralogy of Fallot. J Pers Med 2023; 13:1715. [PMID: 38138942 PMCID: PMC10744881 DOI: 10.3390/jpm13121715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/01/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Although substantial progress has been made to prevent sudden cardiac death in repaired tetralogy of Fallot patients, ventricular arrhythmia and sudden death continue to be major causes of morbidity and mortality in these patients. Greater survival in contemporary cohorts has been attributed to enhanced surgical techniques, more effective management of heart failure, and increased efforts in risk stratification and management of ventricular arrhythmias. More recently, our understanding of predictive risk factors has evolved into personalized risk prediction tools that rely on comprehensive demographic, imaging, functional, and electrophysiological data. However, the universal applicability of these different scoring systems is limited due to differences between study cohorts, types of anatomic repair, imaging modalities, and disease complexity. Noninvasive risk stratification is critical to identify those who may derive benefit from catheter ablation or cardioverter defibrillator implantation for primary prevention. Ultimately, assessment and risk stratification by a multidisciplinary team is crucial to analyze the various complex factors for every individual patient and discuss further options with patients and their families.
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Affiliation(s)
- Eiad Habib
- Division of Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA;
| | | | - Hicham El Masry
- Division of Cardiology, Mayo Clinic, Scottsdale, AZ 85259, USA;
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Dallaire F, Grewal J, Mawad W, Wald RM. Challenges and Opportunities for Patients With Tetralogy of Fallot Across the Lifespan. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:253-255. [PMID: 38161677 PMCID: PMC10755820 DOI: 10.1016/j.cjcpc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Frédéric Dallaire
- Department of Pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jasmine Grewal
- Division of Cardiology, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wadi Mawad
- Division of Cardiology, Montreal Children’s Hospital, McGill University Health Center, Montreal, Québec, Canada
| | - Rachel M. Wald
- University Health Network, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
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