HRS/ISACHD/PACES scientific statement on provider and institutional best practices for comprehensive adult congenital...

The global population of adults with congenital heart disease (CHD) now exceeds that of children, reflecting decades of surgical and medical advances. As this cohort has aged, arrhythmias have emerged as a predominant cause of morbidity, hospitalization, and late mortality. Arrhythmia mechanisms in adult CHD (ACHD) arise from congenital abnormalities, surgically altered substrates, progressive hemodynamic lesions, multisystem comorbidities, and acquired cardiovascular risk factors, creating a distinct electrophysiological (EP) phenotype that diverges fundamentally from that of populations without CHD. Despite increasing complexity and demand, ACHD EP care remains fragmented, with marked variability in provider training, institutional resources, and access to specialized expertise. This joint Heart Rhythm Society/Pediatric and Congenital Electrophysiology Society/International Society for Adult Congenital Heart Disease statement defines provider- and center-level best practices for comprehensive ACHD EP programs. It establishes ACHD EP as a distinct subspecialty and proposes a competency-based framework spanning 5 domains: congenital cardiac anatomy and physiology, arrhythmia mechanisms and risk stratification, noninvasive EP assessment, procedural proficiency in ablation and device therapy, and longitudinal ACHD arrhythmia care. The statement outlines key elements of preprocedural evaluation, procedural planning, and peri- and postprocedural management and specifies institutional requirements for personnel, facilities, and infrastructure. Recognizing the paucity of validated ACHD-specific performance metrics, the document proposes candidate indicators of procedural efficacy, safety, efficiency, longitudinal outcomes, and patient-reported health status and articulates principles for credentialing and institutional accountability. These recommendations are intended as scalable standards to support regional centers of excellence and harmonized training pathways, thereby promoting safe, effective, and equitable ACHD arrhythmia care.