Arrhythmia management: Advances and new perspectives in pharmacotherapy in congenital heart disease

Patients with congenital heart disease and particularly those with previous surgical repair are potentially at risk of brady- and tachy-arrhythmias over the course of their lifetime. Arrhythmias can be associated with significant morbidity and potential mortality in the patient with congenital heart disease and account for a substantial proportion of all hospital admissions in this cohort. The selection of appropriate anti-arrhythmic therapy for these patients presents unique challenges and aspects of care such as ventricular dysfunction, risk of bradyarrhythmia etc. must be taken into consideration. Commonly used and newer agents pertinent to the patient with congenital heart disease will be highlighted here. It should be noted that there is a remarkable paucity of data with respect to the efficacy and safety of anti-arrhythmic agents in this patient cohort and much of what has been reported is derived from small patient series. In addition, published guidelines on arrhythmia management generally do not address the specific needs of this population and, in the absence of randomized controlled trials, management decisions tend to be based on data extrapolated from other patient populations. Nonetheless, with careful appraisal of the potential confounders facing the individual patient when selecting an anti-arrhythmic management strategy, the goals of effective and safe therapy can be attained.