Mechanism and therapy of cardiac arrhythmias in adults with congenital heart disease

Over the past few decades, surgical advances have helped to prolong the lives of many young patients with congenital heart disease (CHD). However, as these patients reach adulthood, they are at risk for many late sequelae of their disease or of their corrective surgery. One of the unique challenges associated with CHD is the high incidence of cardiac arrhythmias that arise from the myocardial substrate created by abnormal pressure/volume changes, septal patches, and suture lines. Medical therapy has proven to be disappointing in treating a majority of these cases. Nonetheless, radiofrequency catheter ablation (RFA), an effective tool in treating atrial and ventricular arrhythmias in structurally normal hearts, has been used to treat arrhythmias in adults with congenital heart disease. This review will discuss some of the common congenital heart diseases in adults and the arrhythmias associated with them, as well as the therapeutic modalities used to treat them. Finally, it will present Mount Sinai Hospital's experience in using RFA for the management of cardiac arrhythmias in adults with congenital heart disease.