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Arrhythmias in congenital heart disease

Patients with congenital heart disease are prone to the entire spectrum of atrial and ventricular arrhythmias. The arrhythmia can be related to the malformation itself (e.g. Wolff–Parkinson–White in Ebstein anomaly), structural remodelling due to ageing/longer life expectancy (e.g. atrial fibrillation), mode of repair (e.g. intra-atrial re-entry tachycardia after right atrial incision or monomorphic ventricular tachycardia after tetralogy of Fallot repair), and severe ventricular dysfunction in those with end-stage heart failure. Therefore, adequate knowledge of the congenital heart defect, its current haemodynamics and arrhythmogenic substrate, precise assessment, and risk stratification will lead to appropriate arrhythmia management. This chapter discusses the diagnosis, assessment, and management of arrhythmia in two adult patients with congenital heart disease. The aim is to offer practical advice for managing these patients, supported by scientific data.