Arrhythmia management for the adult patient with congenital heart disease: an update and analytical review.

Arrhythmia in the adult congenital heart disease (ACHD) population is recognized as a major source of morbidity and mortality and has contributed to an increasing burden on the health care system over the past several decades. Abnormalities of impulse formation and propagation encountered in this population are distinct from those encountered in the general adult population. Such differences are related to the anatomic variability of congenital heart disease, the resulting postoperative hemodynamic disturbances, and the effects of prior cardiac surgery on the underlying myocardial substrate. Effective arrhythmia therapy in this population therefore requires a detailed understanding of these diverse processes and often results in specialized care at regional centers of excellence. Given the large and evolving body of literature dealing with the treatment of cardiac arrhythmia in the congenital heart population, a coherent picture of arrhythmia treatment and efficacy can be difficult to establish. The existing data is therefore dissected and summarized in this manuscript. In addition, recent expert consensus guidelines for the management of arrhythmia in the ACHD population have been published and will be reviewed in this article, with a special emphasis on unique considerations when treating CHD patients presenting with a disturbance in cardiac rhythm.