Prevention and treatment of cardiac arrhythmia in patients with congenital heart defects: surgical aspects

Catheter ablation procedures have become established over the years due to their effectiveness and low invasiveness and have changed the indications for surgical treatment. The main field of activity of cardiac surgery remains the treatment of patients with congenital heart defects which show arrhythmia and necessitate surgical treatment. The combination of surgical ablative measures with a good view of the site using modern ablation instruments, atrial reduction by tissue resection and correction of the defect with the resulting volume relief, bring the best conditions for a curative treatment of arrhythmia. The same applies to the treatment of ventricular tachycardia resulting from old scars and residual defects. Special attention should be given to patients who received a Fontan conversion. This operation is a unique opportunity to relieve volume which in turn reduces the atrial size and at the same time to take ablative measures to restore sinus rhythm. The results are promising with low mortality and morbidity, high efficiency and finally a clear improvement of the functional status of patients. In appropriate cases minimally invasive surgical procedures can help where pharmacological and catheter ablation therapies remain ineffective.