Surgical scars, volume overload and pressure overload are the three main determinants of atrial arrhythmias in patients with prior congenital heart surgery. The workup should include a thorough hemodynamic assessment. Treatment modalities available include drugs, pacemakers, catheter ablation and surgery. Despite the above, arrhythmias have a significant negative impact on life expectancy and quality in these patients. Newer surgical strategies for repair of the heart defect may delay or prevent the development of arrhythmias and are being actively pursued.