What pacing and resynchronization strategies are of most benefit, and when should they be used? Outcomes/risk assessment What criteria should determine transplantation eligibility? Which patients benefit from primary prevention ICDs? How can we risk stratify for SCD in patients with systemic right ventricles? What operative risk score predicts outcomes in ACHD reoperations? What HF risk score predicts outcomes in patients with ACHD? Is there a level of exercise where risk exceeds benefit? What is the rate and/or risk of endocarditis? Assessment Who is at high risk of neurodevelopmental abnormalities and would benefit from neuropsychiatric evaluation and treatment? Who should be screened for anxiety and depression, what treatment is most effective, and are there differences compared with non- patients with ACHD? What is the standard protocol for assessing right ventricular size and function by CMR imaging? Which biomarkers are predictive of mortality and morbidity? (Continued) CLINICAL STATEMENTS AND GUIDELINES structure, which may include a cardiac chamber, coro- nary sinus, superior vena cava, or PA. The incidence of coronary artery fistula is 0.1% to 0.2% in all patients undergoing coronary angiography.S4.4.8-1,S4.4.8-2 Fistulous communications may be congenital or acquired. Spe- cific management strategies, which can include surgical repair or catheter embolization, have been controver- sial. In a series of 46 patients treated with surgery, pre- dominant preoperative symptoms included angina and Importantly, postoperative myocardial infarc- tion occurred in 11% because of low flow in the dilated coronary artery proximal to fistula closure. Late survival was also significantly reduced compared with an age- matched population. The presence of coronary artery fistula(s) requires review by a knowledgeable team that may include congenital or noncongenital cardiologists and surgeons to determine the role of medical therapy and/or percutaneous or surgical closure.S4.4.8-3 Disease-specific Coarctation of the aorta Which measure of hypertension resting, exercise, or ambulatory best predicts outcomes? 