Device therapy for arrhythmia management in adults with congenital heart disease

The number of children with congenital heart disease surviving into adulthood has increased dramatically. Refinement in surgical techniques and effective subsequent care has mainly been responsible for this change. However, many of these survivors have significant lifestyle altering symptoms associated with rhythm disorders. These may result from the primary congenital anomaly or from surgical correction. Tachyarrhythmias often result from re-entrant circuits around surgical scars in the setting of a markedly enlarged cardiac chamber. Symptomatic bradyarrhythmias may result from surgical interruption of the conduction system or from the use of antiarrhythmic medication. The management of these lifestyle altering rhythm disorders frequently involves cardiac devices, including pacemakers, antitachycardia devices, defibrillators and resynchronization devices. We review the underlying causes for common rhythm disorders and discuss the specific challenges with cardiac device use in the adult congenital heart disease population. In addition, we address pacing for improvement of ventricular function and innovations likely to impact the field.