[Arrhythmia after surgery for congenital cardiopathies. What studies? What treatment?].

Cardiac surgery has greatly improved the outlook for patients with heart defects, giving them a much longer lifespan; it has also created specific problems and morbidity, amongst which arrhythmias are most prominent. The incidence of rhythm disturbances increases with age and duration of follow-up. To a large extent, the type of surgery determines the type of arrhythmias: conduction disturbances and ventricular arrhythmias are common after ventricular surgery (e.g. tetralogy of Fallot) whereas sinus node dysfunction, with its bradycardias and tachycardias, is prominent after atrial surgery (e.g. Mustard or Senning operations). Various types of investigations, both non invasive (Holter, exercise testing, signal averaging) and invasive electrophysiology) are available. The usefulness of these different techniques for each type of rhythm disturbance is discussed. Regarding treatment, abstention is the best approach in many cases. Others however require treatment to suppress symptoms and, sometimes, to try and prevent sudden death. The indication for various antiarrhythmic medications and also for pacemaker implantation are discussed. Radio frequency ablation appears to hold some promise for the future.