Arrhythmia surgery

Arrhythmias remain one of the leading causes of death for adults with congenital heart disease. Although catheter ablation is often successful in this population, patients with complex arrhythmia mechanisms or complex cardiac anatomy stand to benefit from surgical ablation, often performed at the time of other indicated cardiac surgery. In the setting of atrial fibrillation, the full biatrial lesion set of the Cox-Maze IV procedure has produced excellent long-term results, with nearly 80% freedom from atrial tachycardias at 5 years, as well as improved long-term survival. A variety of modified lesion sets have been applied to congenital heart patients with success in expert hands, and guidelines for the treatment of arrhythmias in this patient population have recently been created. This chapter reviews the history, indications, techniques, postoperative management, and expected outcomes of arrhythmia surgery in patients with congenital heart disease.