Cardiac Arrhythmias and Their Non-Pharmacological Treatment: An Overview

Arrhythmias represent a significant cause of morbidity and mortality in CHD. They can occur in each phase of the natural history of the disease, from the prenatal period to the late follow-up. Their relevance is increasing especially as a consequence of the good results achieved by corrective surgery, with more and more patients reaching adulthood with the possibility of developing long-term complications, often represented by arrhythmias. Their substrate can depend on the congenital abnormality itself or on surgical scars consequent to its correction, or both. To understand mechanisms underlying arrhythmias, knowledge of the physiology of the normal cardiac conduction system is necessary. This chapter gives an overview of different arrhythmias and their incidence according to the subtype of CHD, also providing basic concepts about their non-pharmacological treatment, in particular cardiac pacing for the treatment of bradyarrhythmias and ablation and ICD implantation for the treatment of tachyarrhythmias. Special emphasis is given to the particular features that arrhythmias have when they occur in congenitally abnormal hearts and in particular to the peculiar aspects of device implantation and arrhythmia ablation in the field of CHD compared to normally structured hearts.