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Arrhythmias in Congenital Heart Disease: Atrial Switch Operations
Cheyenne Beach1, Amit Noheria2, Philip M Chang3
1Department of Pediatrics, Section of Pediatric Cardiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
Cardiac Electrophysiology Clinics
|November 8, 2025
Summary
Arrhythmias frequently cause illness and death after atrial switch surgery for dextro-transposition of the great arteries. Lifelong monitoring and management are essential due to common recurrence despite advancements.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial switch operations for dextro-transposition of the great arteries can lead to significant post-operative morbidity and mortality.
- Arrhythmias are a primary concern in this patient cohort, impacting long-term outcomes.
Purpose of the Study:
- To review the types, substrates, and anatomical considerations of arrhythmias post-atrial switch.
- To outline effective pharmacologic, ablative, and device-based management strategies.
- To emphasize the need for lifelong surveillance due to common arrhythmia recurrence.
Main Methods:
- Review of current literature on arrhythmias following atrial switch procedures.
- Analysis of treatment strategies including medical, interventional, and device-based approaches.
- Discussion of anatomical factors influencing arrhythmia development and management.
Main Results:
- Arrhythmias are a common and serious complication after atrial switch surgery.
- Understanding specific arrhythmia mechanisms and anatomical substrates is crucial for effective treatment.
- Pharmacologic therapy, ablation, and device implantation are key management modalities.
Conclusions:
- Effective management of post-atrial switch arrhythmias requires a comprehensive understanding of underlying mechanisms and anatomy.
- A multidisciplinary approach integrating pharmacologic, ablative, and device therapies is necessary.
- Lifelong surveillance and management are imperative due to the high rate of arrhythmia recurrence.
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