Atrial Arrhythmias in Adults with Repaired Congenital Heart Disease

With advances in surgical and medical care over the past several decades, there has been a marked improvement in survival such that over 90% of children with Congenital Heart Disease (CHD) in developed countries today are expected to survive into adulthood. At present there are currently over 1 million adults with repaired congenital heart in the United States alone, over 100,000 in Canada, and 1.8 million in Europe. However, repaired congenital heart does not equate to a normal heart. In spite of excellent techniques, surgical repairs often left behind prosthetic materials and scars which often became the nidus for reentrant arrhythmias, especially atrial. Although sinus node dysfunction and resultant atrial flutter/ fibrillation become evident in the elderly, comparable atrial arrhythmias will occur among younger ACHD patients often in their second and third decades of life, and can range from asymptomatic to hemodynamically significant and potentially lethal. In the long term, arrhythmias are a leading cause of morbidity and mortality in adults with repaired CHD. This review discusses current approaches to atrial arrhythmia identification and management among ACHD patients.