With the advance of surgical technique and perioperative care, the mortality of congenital heart disease has decreased markedly since 1990. In nowadays, most of the congenital heart disease patients can survive into adulthood, and the long term complication including tachyarrhythmia and bradyarrhythmia became an important issue in these repaired congenital heart disease (rCHD) patients. The prevalence of atrial arrhythmia and ventricular arrhythmia all increased with advanced age and may occur in more than 15% of these rCHD patients. The common tachyarrhythmia include ventricular tachycardia, supraventricular tachycardia, and atrial flutter/IART (intra-atrial reentry tachycardia).
　　Ventricular arrhythmia can be a cause of sudden cardiac death long term after CHD repair. The most common associated CHD include TOF, aortic and subaortic stenosis, and some COA. The mechanism of ventricular arrhythmia in these patients is through mechano-electrical interaction. Therefore, correction of hemodynamic problem, like pulmonary regurgitation and right ventricular dilatation in TOF and LVOT obstruction in AS/subaortic stenosis, is important to prevent further ventricular arrhythmia. Although catheter ablation can be effective in some patients, recurrence is common and ICD (implantable cardiovertor defibrillator) implantation is often necessary and indicated.
　　Supraventricular tachycardia is sometimes associated with CHD like Ebstein's anomaly patients. Transcatheter ablation has high success rate but recurrence is higher in these CHD patients than general population. For the postoperative atrial arrhythmia in rCHD, atrial flutter (AF) and IART are the most common but also most difficult to treat. The presence of the atrial arrhythmia may increase morbidity and mortality in these patients, therefore aggressive treatment is necessary. Medical treatment seldom succeeds and device therapy is sometimes helpful, mostly in post-atrial switch in TGA patients. Surgical revision with concomitant cryoablation can be performed in selected patients if hemodynamic problem exists. The transcatheter ablation is most commonly used and most effective method in the treatment of these patients. The introduction of Carto guided 3D mapping greatly increase the success rate and should be used in these complex anatomy patients.
　　For the bradyarrhythmia, atrioventricular block often presents immediately after surgery, and pacemaker implantation is needed if not recovery within 10-14 days. Sick sinus syndrome is a not uncommon late problem in those receiving extensive atrial surgery like Fontan or atrial switch operation. Pacemaker is also helpful in these patients.