Trends in Arrhythmia-Related Mortality Associated With Congenital Heart Disease in the United States.

BACKGROUND: Improved medical care has increased survival for patients with congenital heart disease (CHD), but arrhythmias remain a major cause of death. Population-based trends in arrhythmia-related mortality associated with CHD are not well defined. OBJECTIVES: This study aimed to evaluate population-based trends and disparities in arrhythmia-related mortality involving CHD as a contributing cause of death in the United States from 1999 to 2024. METHODS: This retrospective analysis used multiple cause-of-death records from the CDC (Centers for Disease Control and Prevention) WONDER (Wide-ranging Online Data for Epidemiologic Research) database to examine long-term trends and disparities in arrhythmia-related mortality associated with CHD from 1999 to 2024. Age-adjusted mortality rates (AAMRs) were calculated by sex, age, race/ethnicity, census region, and urbanization level. Trends were evaluated using Joinpoint regression. Exploratory ARIMA (Autoregressive Integrated Moving Average) projections were generated through 2034. RESULTS: From 1999 to 2024, 24,711 arrhythmia-related deaths involving documented CHD were identified. The overall AAMR declined from 0.42 in 1999 to 0.30 in 2024. Males had consistently higher mortality. All racial groups showed declines, but non-Hispanic Black individuals had the highest rates. Large metropolitan areas experienced the most rapid decline, while rural areas had persistently elevated mortality. Infants had the highest mortality, while ages 15 to 24 showed the fastest decline. In contrast, adults ≥55 years of age demonstrated increasing mortality beginning in the mid-2000s, most prominently in those 75-84 years of age. Exploratory projections suggest overall AAMR will stabilize around 0.30 through 2034, with continued increases in the 75-84-year group. CONCLUSIONS: Arrhythmia-related mortality associated with CHD declined over 26 years, but progress has stalled or reversed since 2012, especially among the elderly, certain regions, and racial groups.