PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease
Abstract
The Pediatric and Congenital Electrophysiology Society (PACES), in conjunction with the Heart Rhythm Society (HRS), appointed a 22-member writing committee from the United States, Canada, and Europe with complementary multidisciplinary expertise in pediatric and adult electrophysiology, adult CHD, and CHD surgery. The writing committee included representation from the American College of Cardiology (ACC), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Canadian Heart Rhythm Society (CHRS), and International Society for Adult Congenital Heart Disease (ISACHD).
The committee was divided into subgroups to review key aspects in the recognition and management of arrhythmias in adults with CHD. Experts in the topics under consideration were tasked with performing formal literature reviews, weighing the strength of evidence for or against diagnostic and therapeutic interventions, estimating expected health outcomes where relevant, and proposing practical clinical recommendations.
Wherever possible, recommendations are evidence-based. However, unlike some practice guidelines, there is not a sizeable body of literature with definitive evidence to support most recommendations in this emerging field of cardiology.
In order to maximize the value and credibility of consensus-based recommendations, a high-threshold (i.e., 80% or greater agreement among writing members) was required to constitute a consensus. Supportive evidence is indicated where appropriate, and variations in opinion are nuanced in the text.
As a general recommendation, the committee strongly supports expanding the evidence base related to arrhythmias in adults with CHD through participation in research and clinical registries.