With the evolution of treatment of congenital heart disease, an increasing number of paediatric patients who suffer either simple or complex heart disease reach adolescence and the adult age. Many of these cardiac alterations are associated with the development of arrhythmias, sometimes associated to the disease (e.g.: WPW with Ebstein anomaly), sometimes secondary to its treatment (AV conduction disease following correction of L-transposition of the great arteries, arrhythmias related to surgical sutures in the heart) and sometimes due to the disease’s impact on cardiac tissue. It is not uncommon to find alterations in the heart’s electrical conduction after surgical intervention of congenital heart disease, often requiring implantation of a cardiac pacemaker.
Atrial arrhythmias such as typical and atypical atrial flutter as well as atrial fibrillation related to post-surgical scars and dilatation of the atria can occur afer surgical techniques such as Mustard, Fontan, Ebstein… or even after more simple interventions such as closure of atrial septal defect. They can be treated with drugs and/or catheter ablation, which should be performed in specialized centres with advanced imaging techniques such as 3D electroanatomical navigation. These interventions are complex and require multidisciplinary teams with wide experience.
Finally, the more severe ventricular arrhythmias can be associated to surgical correction of diseases such as Fallot tetralogy and Mustard correction, left-sided stenosis, etc. Both pharmacologic and catheter-based treatments are treatment options. The latter requires a highly specialized setting, as explained above. Implantation of an automatic defibrillator (ICD) may also be necessary..
