Surgical therapy of arrhythmias and conductive disorders

Arrhythmia surgery has evolved from an isolated procedure for refractory arrhythmia to incorporation into the repair of concurrent hemodynamic problems. Recognition of the increasing incidence of arrhythmias following repair of congenital heart disease and the need for reoperations to improve hemodynamics has led to a combined electrical-hemodynamic approach to congenital heart surgery. Knowledge of the specific arrhythmia mechanisms, anatomic variants posed by congenital lesions, and the basics of arrhythmia surgical techniques available for therapy will lead to routine incorporation of this strategy into surgery for congenital heart disease. Improvements in device technology have led to more widespread application of pacing and device therapies at younger ages. The next phase of arrhythmia surgery will be the incorporation of prophylactic antiarrhythmia strategies into the initial repairs of complex congenital heart disease.