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

JAMA Cardiol. 2020 Dec 1;5(12):1435-1444. doi: 10.1001/jamacardio.2020.3416.


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.

Publication types

  • Review

MeSH terms

  • Adult
  • Cardiovascular Surgical Procedures
  • Electrocardiography*
  • Heart Defects, Congenital / physiopathology*
  • Heart Defects, Congenital / surgery
  • Humans
  • Risk Assessment