Radiofrequency Ablation in Patients with Congenital Heart Disease: a Review

THE RELATIVELY BENIGN NATURE of paroxysmal supraventricular tachycardia (PSVT) in patients with normal cardiovascular systems stands in sharp contrast to the malignant nature of supraventricular arrhythmias encountered in patients with structural heart anomalies.I-3 Risk is especially high after complex corrective or palliative heart surgery. Patients after Fontan palliation for functionally single ventricle, patients after atrial rerouting for complete transposition of the great arteries, and patients after other complex atrial surgery may develop potentially lethal intra-atrial reentrant tachycardia (IART). Although similar in nature to atrial flutter, IART is often more difficult to manage, in part due to the presence of multiple reentrant circuits in the atria. Abnormal ventricular myocardium is frequently a part of congenital cardiovascular anomalies, especially in older patients. The abnormal myocardium and post-myotomy scars produce a substrate for malignant ventricular tachyarrhythrnias. Sudden cardiac death has been well documented in patients with congenital heart disease. It is imperative that arrhythmia in children, adolescents, and adults with congenital heart disease be treated aggressively using all possible therapeutic options. In many cases of postoperative arrhythmias, medical or surgical improvement in hemodynamic function will rectify rhythm disturbances. Antiarrhythmic agents are, in general,