Atrialarrhythmias,includingatrialfibrillation,inthesettingofcongenitalheartdisease(CHD)areepidemiologicallyandmechanisticallydifferentfromthoseencounteredinthegeneralpopulation.ThesearrhythmiasoccuratyoungeragesinpatientswithCHD,andarefrequentlydegenerativeandprogressive.Theepidemiology,incidence,andprevalenceofthespectrumofatrialarrhythmias,includingatrialfibrillation,varyaccordingtothespecificCHDtype,priortreatment,andresidualandongoingstructuralandfunctionalsequelae.Thecombinedimpactofincisionalscars,abnormalhemodynamics,atrialchamberdilatation,andincreasesinatrialwallthicknessanddistributionoffibrosisresultsinahighlydynamicandcontinuouslychangingatrialsubstratethatishighlypredisposedtoarrhythmias.Giventhemultiplesubstrates,inpidualizedtherapeuticplanscanincludepharmacologictherapy,catheter-basedablation,andsurgicaltherapiesperformedconcomitantlywithprimarysurgicalinterventionforhemodynamicallysignificantsequelaeofCHD.AdvancedimagingwithCTorMRIcanprovidevaluableinformationfordecisionmakingandproceduralplanning.ApplicationofnoveltherapeutictechnologiesandpharmacologicagentsnecessitatesspecialconsiderationswhenappliedtotheCHDpopulationandrequiresgreaterstudyinspecificsubsetsofCHDpatients.
