We are now approaching year three of the Global COVID-19 pandemic, and it is still very much in the headlines. Vaccination recommendations are changing rapidly within a span of less than a year.¹ The previous practice of rationing vaccines has evolved into age based universal recommendations. With novel emerging practices regarding booster shots² and inclusion of children as young as 5 years,³ it is our hope that the pandemic will become endemic and that the future will no longer be as disconcerting, despite the reports of new viral strains.

We are learning more about the impact of COVID-19 in children and in those with congenital heart disease (CHD). CHD is heterogenous with a wide spectrum of severity. Those who are in a hemodynamically decompensated state appear to be more vulnerable.⁴ At the onset, children were thought to be spared the devastating effects of COVID-19, but over time, post-acute sequelae became evident.⁵ Cardiovascular involvement in COVID-19 are common, and the possibility of long-term myocardial injury in convalescing patients is concerning.⁶

Multi-system inflammatory syndrome in children or MIS-C, a disease entity first described in 2020, continues to be a perplexing paradigm.⁷ Clinicians in the trenches are finding novel uses of old drugs for this new disease entity.⁸ How to navigate concomitant financial constraints⁹ in the practice of cardiovascular medicine in the current climate presents challenges. Additionally, women in cardiology (WIC) still continue to juggle roles not inherently demanded from their male colleagues.¹⁰

The importance of clinical informatics has been recognized for many years, but the SARS-CoV-2 pandemic has served as an unwitting catalyst requiring the  quick implementation of new technological solutions. Clinician experts in informatics are needed to lead healthcare practices and organizations through digital transformation, empowering us to use technology efficiently and to its greatest potential, such that it may indeed become a true, emerging sub-specialty in our field.¹¹

Undoubtedly, the number one topic for 2021 was still the COVID-19 pandemic. But the world of cardiovascular disease does not take a pause. Being the professional home for the Congenital Heart Disease and Pediatric Cardiology Clinical Topic Collection, we at ACC.org always aspire to provide curated, relevant content for your clinical practice. One of the emerging trends in clinical medicine is the development of niche, specialty practices. It makes sense to prioritize complex cases to high volume centers of expertise, with the goal of improving overall outcomes. For example, a collaborative multi-disciplinary approach for lead extraction in patients with complex CHD maximizes procedural efficacy and safety, especially in post-operative cases undergoing combined interventional and electrophysiology procedures.¹²

Anomalous origin of coronary arteries is now increasingly recognized.¹³ This disease entity may have devastating effects and the ideal goal is to strive for a diagnosis before a catastrophic sentinel event.¹⁴

In this modern era with no less than an on-going pandemic, physician burnout continues to be a concern for pediatric and adult congenital cardiologists.¹⁵ Burnout is multifaceted, and thus requires a multipronged approach to move us from the current to an ideal future state. Promoting psychologic safety in all our practices, especially for women and minorities in our field, is one way to mitigate this smoldering issue.¹⁶

Lastly, 2021 was the inaugural year of the long awaited ACPC Question of the Month. Many thanks to Dr. Frank Ing and his team of experts for bringing this to fruition. Providing a facile, streamlined way to obtain American Board of Pediatrics Maintenance of Certification (ABP MOC) credits to our ACC membership is a priority of ACPC leadership.

As always, we are pleased that many have volunteered content for publishing on our website. Please contact Christi Plaster at cplaster@acc.org to propose topics for discussion or submit interesting cases for digital publication.

It is an honor to be the digital home for Adult Congenital and Pediatric Cardiology (ACPC). On behalf of Arwa Saidi, MB, B.Ch., FACC, Chair of the ACPC Council, and Ami B. Bhatt, MD, FACC and Robert "Jake" D.B. Jaquiss, MD, FACC, Associate Editorial Team Leads of the Congenital Heart Disease and Pediatric Cardiology Clinical Topic Collection, we join you in welcoming 2022! Cheers to new beginnings!

References

1. Driggin E, Maddox TM, Ferdinand KC, et al. ACC health policy statement on cardiovascular disease considerations for COVID-19 vaccine prioritization: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021;77:1938–48.
2. FDA Authorizes Pfizer COVID-19 Vaccine Booster Dose in Certain Patients. https://www.acc.org. Sep 23, 2021. Accessed 11/26/2021. https://www.acc.org/Latest-in-Cardiology/Articles/2021/09/23/18/57/FDA-Authorizes-Pfizer-COVID-19-Vaccine-Booster-Dose-in-Certain-Patients.
3. FDA Authorizes Pfizer COVID-19 Vaccine in Children Ages 5-11. https://www.acc.org. Oct 29, 2021. Accessed 11/26/2021. https://www.acc.org/Latest-in-Cardiology/Articles/2021/10/29/20/29/FDA-Authorizes-Pfizer-COVID-19-Vaccine-in-Children-Ages-5-11.
4. Awerbach J, Lantin-Hermoso MR, Saidi A. COVID-19 Vaccination in Adults with Congenital Heart Disease. https://www.acc.org. Feb 24, 2021. Accessed 11/26/2021. https://www.acc.org/latest-in-cardiology/articles/2021/02/24/13/44/covid-19-vaccination-in-adults-with-congenital-heart-disease.
5. Verma AK. In the ongoing conflict between ideology and immunity, which side will protect the children from post-acute sequelae of COVID-19? J Am Coll Cardiol Basic Trans Science 2021;6:812-13.
6. Petersen SE, Friedrich MG, Leiner T, et al. Cardiovascular magnetic resonance for patients with COVID-19. JACC Cardiovasc Imaging 2021;Oct 7:[Epub ahead of print].
7. Fundora MP, Oster M. Ten Things to Know About MIS-C. https://www.acc.org. Nov 02, 2021. Accessed 11/26/2021. https://www.acc.org/Latest-in-Cardiology/Articles/2021/11/02/14/41/Ten-Things-to-Know-About-MIS-C.
8. What is the Safety, Efficacy of Metoprolol Therapy in Critically Ill COVID-19 Patients? https://www.acc.org. Aug 30, 2021. Accessed 11/26/2021. https://www.acc.org/Latest-in-Cardiology/Articles/2021/08/30/20/01/What-is-the-Safety-Efficacy-of-Metoprolol-Therapy-in-Critically-Ill-COVID-19-Patients.
9. HHS Releases $25.5 Billion in COVID-19 Relief Funding. https://www.acc.org. Sep 16, 2021. Accessed 11/26/2021. https://www.acc.org/Latest-in-Cardiology/Articles/2021/09/16/17/08/HHS-Releases-25-Billion-in-COVID-19-Relief-Funding.
10.  Jain SS. Mother's Day in the COVID-19 Pandemic. https://www.acc.org. May 20, 2021. Accessed 11/26/2021. https://www.acc.org/membership/sections-and-councils/women-in-cardiology-section/section-updates/2021/05/20/00/29/mothers-day-in-the-covid-19-pandemic.
11.  Liou A. Informatics: An Emerging Sub-Specialty in Cardiology. https://www.acc.org. Feb 09, 2021. Accessed 11/26/2021. https://www.acc.org/latest-in-cardiology/articles/2021/02/08/19/44/informatics-an-emerging-sub-specialty-in-cardiology.
12.  Lam WW, Mah DY, Kim JJ. Developing a Lead Extraction Program for Patients with Complex CHD. https://www.acc.org. May 20, 2021. Accessed 11/26/2021. https://www.acc.org/Latest-in-Cardiology/Articles/2021/05/20/13/01/Developing-a-Lead-Extraction-Program-for-Patients-with-Complex-CHD.
13.  Doan T, Molossi S. Ten Points to Remember: Myocardial Ischemia in Anomalous Aortic Origin of a Left Coronary Artery with an Intraseptal Course. https://www.acc.org. Mar 10, 2021. Accessed 11/26/2021. https://www.acc.org/latest-in-cardiology/articles/2021/03/10/13/44/myocardial-ischemia-in-anomalous-aortic-origin-of-a-left-coronary-artery.
14.  Bright C, Seitz A, Seery TJ. Cardiac Arrest in an 8-Year-Old. https://www.acc.org. Aug 20, 2021. Accessed 11/26/2021. https://www.acc.org/education-and-meetings/patient-case-quizzes/2021/08/20/12/25/cardiac-arrest-in-an-8-year-old.
15.  Border WL Asaki Y, Etheridge SP, Saidi A. Physician Wellness for Pediatric and Congenital Cardiologists: What Can We Do Now? https://www.acc.org. Jul 19, 2021. Accessed 11/26/2021. https://www.acc.org/latest-in-cardiology/articles/2021/07/19/13/42/physician-wellness-for-pediatric-and-congenital-cardiologists.
16.  Webb M, Puri K, Ansah D. Promoting Psychological Safety in Pediatric Cardiology. https://www.acc.org. Sep 14, 2021. Accessed 11/26/2021. https://www.acc.org/latest-in-cardiology/articles/2021/07/19/13/42/physician-wellness-for-pediatric-and-congenital-cardiologists.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, COVID-19 Hub, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Stress

Keywords: COVID-19, SARS-CoV-2, COVID-19 Vaccines, RNA, Viral, Cardiovascular Diseases, Cardiologists, Coronary Vessels, Leadership, Pandemics, Heart Defects, Congenital, Medical Informatics, Clinical Medicine, Electrophysiology, Certification, Vaccination, Power, Psychological, Delivery of Health Care, Pediatrics, Technology, Vaccines, Burnout, Psychological, Pharmaceutical Preparations

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