Cardiac resynchronization therapy (CRT) is a commonly used procedure to help patients with drug refractory heart failure (HF) symptoms. More patients with congenital heart disease (CHD) survive to adulthood with the improvements that have occurred as a result of surgical and medical care of these patients. However, patients with CHD may develop ventricular dysfunction and HF and thus be considered for CRT. In this review, we discuss the unique features of CRT in the adult CHD population. We examine the existing data on utilization of CRT in patients with HF and CHD and specifically discuss the limitations in terms of benefit as well as data availability. Finally, we review the specific coronary sinus anatomy and technical considerations for placing a left ventricular lead in patients with CHD.