The role of concomitant arrhythmia surgery in patients undergoing repair of congenital heart disease.

Long-term survival after repair of complex congenital heart lesions is associated with the late development of arrhythmias as well as residual hemodynamic abnormalities. Understanding arrhythmias as electromechanical problems provides the basis for surgical intervention to correct the arrhythmia as well as anatomical disturbances. Operative techniques are highly effective in treating atrial reentry tachycardia and atrial fibrillation. Surgery for ventricular tachycardia is less effective: the arrhythmia may be reduced by improving hemodynamics, but a defibrillator may be required. Integration of device therapy into surgery may improve outcomes by preventing bradycardia as a precursor to tachycardia, and optimizing ventricular synchrony.