Congenital heart disease is the most prevalent type of inborn defect, with a rapidly growing and aging patient population that is increasing in complexity. Indicative of the remarkable progress in pediatric cardiac care, adults now outnumber children with congenital heart disease. Adults with congenital heart disease constitute a distinct and heterogeneous population of patients with unique needs, concerns, and challenges. Arrhythmias figure foremost among the issues encountered and are the leading cause of morbidity, hospital admissions, and mortality. Several novel and singular challenges of unparalleled diversity are encountered in the arrhythmia management of adults with congenital heart disease and span the entire spectrum of bradyarrhythmias and tachyarrhythmias. The nascent field of adult congenital electrophysiology requires an integration of standard electrophysiology proficiencies with a thorough appreciation for congenital heart disease anatomy, physiology, and surgical interventions. The objective of this review is to highlight commonly confronted arrhythmia issues and themes, discuss particular challenges, review recent relevant literature, and summarize current management trends.