Common arrhythmias and their management in the adolescent with congenital heart disease

Congenital heart disease (CHD) is a relatively common congenital anomaly with a wide range of complexity. Different types of CHD carry specific risks for bradyarrhythmias, tachyarrhythmias, or both. These risks and any symptoms guide testing and monitoring strategies. Novel techniques and devices allow for individualized care incorporating short- and long-term risks and benefits.

Changes to approaches in pacemaker lead placement have improved the treatment of cardiac dyssynchrony and the prevention of pacing-induced cardiomyopathy. Catheter ablation is increasingly a primary strategy for tachyarrhythmia management, due to high success rates and infrequent complications. For example, ablation of vulnerable isthmuses in patients with Tetralogy of Fallot prior to transcatheter pulmonary valve replacement is thought to decrease risk of ventricular tachycardia. New techniques and devices allow for more options for adolescent patients who require device implantation. This review will focus on arrhythmias that occur in adolescents with CHD and current strategies for their diagnosis and treatment.

Adolescents with CHD have unique needs during this time of transition toward healthcare independence. A structured program that addresses arrhythmia and other needs with consideration of long-term benefits and risks can improve quality of life for adolescence and beyond.