Arrhythmia Management in Adults with Congenital Heart Disease

Arrhythmias are a major cause of morbidity in adults with congenital heart disease (CHD), are known to increase with increasing age, and are a frequent reason for hospital admission. Arrhythmias are a leading cause of death in adults with congenital heart disease in many countries. Over time and with surgical advancement, survival to adulthood with congenital heart disease is improving and we are now seeing many older adults with CHD. Multiple factors contribute to the pathophysiology and substrate for tachyarrhythmias and bradyarrythmias in adults with CHD. Evaluation of arrhythmias in adults with repaired congenital heart disease is dependent upon type of lesion, type of repair, age of patient, and symptoms. While data regarding evaluation and management of arrhythmias in adults with CHD is far more limited than the data that exists for adults with acquired heart disease, expert consensus does guide management. Risk of bradyarrhythmias, atrial tachyarrhythmias, ventricular tachyarrhythmias, and sudden cardiac death varies based on congenital anatomy, surgical repair, residual hemodynamic abnormalities, and patient symptoms. It remains vital that medical care of adults with CHD is provided in close concert with specialists in adult congenital heart disease.