[Arrhythmias after surgery for congenital heart disease]

The improvement of surgical techniques over the last few years have made postoperative chronotropic insufficiency either by sinus node dysfunction or iatrogenic atrioventricular block less common. However, reentrant tachycardia around lines of incision or a patch may be observed. Persistent dilatation of a cardiac chamber or ventricular dysfunction are predisposing factors. Flutter-like arrhythmias occur mainly after atrial surgery (closure of atrial septal defects, Mustard, Senning or Fontan procedures). Ventricular tachycardias are observed more often after correction of tetralogy of Fallot or in patients with severe ventricular dysfunction. In fact, any type of arrhythmia may arise, especially when the lesion is operated late in childhood or in adulthood with a partial haemodynamic result (residual gradient, valvular regurgitation or ventricular dysfunction...). In this context, regular ECG follow-up should be associated with repeated Holter monitoring and exercise stress testing. From the therapeutic point of view, amiodarone remains the best antiarrhythmic drug. Radiofrequency ablation techniques represent a recent but decisive advance in the management of atrial arrhythmias.