There are now more adults living with a history of congenital heart disease than there are children. Modern electrophysiologists must familiarize themselves with the most common congenital lesions requiring electrophysiologic care as adults. Advancements in this field have been made most notably with high-resolution 3D imaging and electroanatomic mapping, left ventricular cannulation techniques, alternative pacing strategies, intracardiac echo, and transeptal access tools.