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Antiarrhythmic Medications in Patients with Adult Congenital Heart Disease

Rawan Amir1, Jenna A Milstein1, Konstantinos N Aronis2

  • 1Division of Cardiology, Johns Hopkins Hospital, Sheikh Zayed Tower 7120, 1800 Orleans Street, Baltimore, MD 21287, USA.

Cardiac Electrophysiology Clinics
|January 29, 2026
PubMed

Insights

Anti-arrhythmic drugs (AADs) are crucial for managing arrhythmias in adults with congenital heart disease (ACHD). This review offers guidance on AAD selection tailored to specific ACHD conditions and patient physiology.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Adult Congenital Heart Disease

Background:

  • Arrhythmias significantly impact morbidity and mortality in the growing adult congenital heart disease (ACHD) population.
  • Anti-arrhythmic drugs (AADs) remain vital for managing arrhythmias in ACHD patients, despite advancements in catheter ablation.
  • Current guidance on AAD use in the diverse ACHD population is limited.

Purpose of the Study:

  • To provide a comprehensive overview of arrhythmias in various ACHD conditions.
  • To discuss physiological considerations relevant to AAD use in ACHD.
  • To outline strategies for selecting AADs tailored to specific ACHD patient profiles.

Main Methods:

  • Literature review of arrhythmias in ACHD.
  • Analysis of physiological factors influencing AAD efficacy and safety in ACHD.
  • Pharmacological profile of commonly used AADs.

Main Results:

  • Detailed overview of common arrhythmias across different ACHD diagnoses.
  • Identification of key physiological factors (e.g., single ventricle physiology, prior surgeries) impacting AAD management.
  • Comparison of AAD properties and their suitability for specific ACHD scenarios.

Conclusions:

  • Tailored AAD selection is essential for effective arrhythmia management in ACHD.
  • Understanding ACHD-specific physiology is critical for optimizing AAD therapy.
  • Further research is needed to refine AAD guidelines for the ACHD population.

Keywords:
Adult congenital heart diseaseAnti-arrhythmic drugsEbstein’s anomalyFontan palliationTetralogy of fallotTransposition of great arteries

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