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Arrhythmias are among the most frequent and serious complications in patients with adult congenital heart disease. The arrhythmogenic substrate is specific for different congenital heart diseases, either due to congenital anatomical malformations or as a result of surgical repair. Given the often borderline haemodynamic status, rhythm-control therapy is preferred, including the use of interventional methods (catheter ablation, pacemaker/cardioverter implantation, resynchronisation therapy). Periodic and thorough risk stratification is essential in the prophylaxis of sudden cardiac death. Patients with arrhythmias and severe congenital heart disease should be managed and treated in superspecialised expert centres. The aim of this article is to review the recent knowledge and guidelines for the care of these patients. [ABSTRACT FROM AUTHOR]

Congestive heart failure (HF) is a progressive disease defined as the inability of the heart to maintain adequate blood flow. Ventricular arrhythmias (VAs) are common in patients with HF. Moreover, an advanced HF increases the risk of VAs. The management of VAs in patients with HF requires a systematic, multimodal approach consisting of an optimized medical therapy, use of ICD and/or cardiac resynchronization therapy. Another possibility is catheter ablation (CA), which is the method of choice for arrhythmia-induced cardiomyopathy and may represent a life-saving procedure for patients with electric storm. Novel approaches in the treatment of refractory VAs include modulation of the autonomic nervous system and stereotactic radiotherapy. In patients with end-stage HF with VAs, implantation of mechanical cardiac support or heart transplantation can be considered. The purpose of this review is to provide an overview of strategies used for the treatment of VAs in patients with HF with an emphasis on interventional options. [ABSTRACT FROM AUTHOR]

Catheter ablation is an effective method for the treatment of cardiac arrhythmias. In some patients, the arrhythmogenic substrate can be located on the epicardial aspect of the cardiac chambers and may be inaccessible from the endocardium. Therefore, percutaneous epicardial access to the pericardium has been introduced. Currently, it is used for patients in whom endocardial ablation has failed or in whom imaging studies or ECG characteristics suggest the presence of an epicardial substrate. Other indications include specific myocardial diseases, such as arrhythmogenic cardiomyopathy and Brugada syndrome. The aim of our paper is to review current techniques and potential complications associated with percutaneous epicardial mapping and ablation. Additionally, a brief analysis of a patient cohort from our center is presented. [ABSTRACT FROM AUTHOR]