Ablation of Ventricular Arrhythmias in GUCH: The Surgical Scar and the Second Substrate

Patients with grown-up congenital heart (GUCH) disease pose a few unique problems for the cardiac electrophysiologist due to the myocardial substrate with high propensity for arrhythmias. Arrhythmias are the main reason for hospital admission in these patients and, unfortunately, in a significant proportion of these patients, these arrhythmic events could be life-threatening [1]. Furthermore, the onset of arrhythmias may herald the hemodynamic decompensation in a sizable segment of the population with already compromised functional status. The abnormal circulation, in turn, may amplify the hemodynamic effect of arrhythmias in these patients with unrepaired or partially repaired abnormal cardiac anatomy.