Current state of the art for use of pacemakers and defibrillators in patients with congenital cardiac malformations

As patients with congenital cardiac malformations increasingly survive therapeutic interventions, and our understanding of primary electrical diseases increases, the landscape of paediatric and congenital electrophysiology is expanding. Electrophysiologic abnormalities, both tachycardic and bradycardic, are commonly seen in post-operative patients with congenital cardiac disease, as well as being part of the natural history of congenital malformations and cardiomyopathies. Disturbances of rhythm represent an increasing morbidity in this population, and therapies using devices in the form of pacemakers and implantable cardioverter-defibrillators have taken on a correspondingly important role. In this review, we discuss some of the key features and recent advances in pacing for bradycardia, resynchronization pacing, anti-tachycardia pacing, and use of implantable cardioverter-defibrillators.