Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort

Valente, Anne Marie; Gauvreau, Kimberlee; Assenza, Gabriele Egidy; Babu‐Narayan, Sonya V.; Schreier, Jenna; Gatzoulis, Michael Α.; Groenink, Maarten; Inuzuka, Ryo; Kilner, Philip J.; Koyak, Zeliha; Landzberg, Michael J.; Mulder, Barbara J.M.; Powell, A.; Wald, Rachel M.; Geva, Tal

doi:10.1136/heartjnl-2013-304958

Cited by 413 publications

(253 citation statements)

References 27 publications

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“…Ratio ≥ 0.3 of RV mass-to-volume for rTOF patients was sufficient to reach high risk regarding adverse outcomes (HR 5.04, 95% CI 2.3-11.0, p < 0.001) [26]. Additionally, LV and/or RV dysfunction and documented atrial tachyarrhythmia may independently increase the probability of life-threatening outcomes.…”

Section: Right Ventricular Hypertrophymentioning

confidence: 95%

“…Presence of documented atrial arrhythmias (described as atrial flutter, AF or SVT) in rTOF patients plays a predictive role in risk stratification for VT and SCD (HR 3.65 (95% CI 1.75-7.62, p = 0.001)) [26]. Echocardiography-based study found that most of undocumented arrhythmias were likely to be supraventricular and linked to increased right atrial (RA) size [27].…”

Section: Supraventricular Arrhythmiasmentioning

confidence: 99%

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Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Grigaliūnas

Gumbienė

Valevičienė

et al. 2015

Seminars in Cardiovascular Medicine

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SummaryTetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart defect. Over the last century, the life expectancy of TOF patients has significantly improved. This, however, has brought new challenges both to patients and their health-care providers, the main of them being late arrhythmia. Ironically, late arrhythmia is predominantly generated due to the fibrotic scars caused by the life-saving surgical repair. Once the first two mainly arrhythmia-free decades after the repair pass, the risk of developing late arrhythmia and, therefore, SCD becomes substantial. Consequently, young adults with repaired Tetralogy of Fallot (rTOF) require careful outpatient monitoring.There have been many attempts to predict the risk of life-threatening arrhythmia in rTOF patients. This has led to the defining of various risk factors, ranging from the widely used QRS prolongation to novel predictors, derived from cardiac magnetic resonance (CMR) based anatomical findings (left ventricular dyssynchrony indexes, right ventricular output tract akinetic length, right ventricular mass-to-volume ratio). The latter predictors have recently established CMR as a tool of high significance in evaluation of rTOF patients.Although the role of Holter monitoring findings in rTOF patient-assessment remains unclear, it may be useful in those who are 25 years and older. Implantable cardioverter-defibrillator (ICD) implantation is the first-line treatment for secondary prevention of sudden cardiac death (SCD). rTOF patients suffer from the highest rate of inappropriate and the lowest rate of appropriate ICD shocks, when compared to other congenital heart diseases. As a consequence, ICD implantation for primary SCD prevention should be carefully weighed. Catheter-based ablation therapy leads to high rate of initial success when abolishing monomorphic ventricular tachycardia and intra-atrial reentrant tachycardia, however recurrence rates remain high. Seminars in Cardiovascular Medicine

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Section: Right Ventricular Hypertrophymentioning

confidence: 95%

Section: Supraventricular Arrhythmiasmentioning

confidence: 99%

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Grigaliūnas

Gumbienė

Valevičienė

et al. 2015

Seminars in Cardiovascular Medicine

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“…Other suggested risk factors that may not be as strongly associated with SCD include older age (after the first decade of life) at the time of complete repair, a history of syncope or rapid palpitations, extensive right ventricular fibrosis on cardiac magnetic resonance imaging (MRI) scan, elevated left ventricular end diastolic pressure, non-sustained VT on ambulatory cardiac monitor, and atrial arrhythmias. 16,18,[20][21][22][23] The presence of a single risk predictor portends only moderate risk of SCD. 20 In patients with moderate risk (ie, the presence of a single risk factor, symptoms suggestive of VAs without ambulatory monitor documentation), inducible VA at electrophysiology study (EPS) is considered to be predictive of clinical malignant arrhythmias.…”

Section: Risk Stratificationmentioning

confidence: 99%

“…16,18,[20][21][22][23] The presence of a single risk predictor portends only moderate risk of SCD. 20 In patients with moderate risk (ie, the presence of a single risk factor, symptoms suggestive of VAs without ambulatory monitor documentation), inducible VA at electrophysiology study (EPS) is considered to be predictive of clinical malignant arrhythmias. EPS does not, however, predict adverse events in asymptomatic patients without risk factors.…”

Section: Risk Stratificationmentioning

confidence: 99%

The Use of Implantable Cardioverter-defibrillators in the Prevention of Sudden Cardiac Death: A Focus on Congenital Heart Disease and Inherited Arrhythmia Syndromes

Goldstein

Ward

Al‐Khatib

2017

J Innov Cardiac Rhythm Manage

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“…[1][2][3] However, early identification and characterization of a poorly adapting RV, and consequently RV failure, continues to be difficult.…”

Section: Introductionmentioning

confidence: 99%

Regional right ventricular remodeling and function in children with idiopathic pulmonary arterial hypertension vs those with pulmonary valve stenosis: Insights into mechanics of right ventricular dysfunction

et al. 2017

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Background Right ventricular (RV) pressure overload in the context of pulmonary stenosis (PS) has a much better prognosis than in the context of idiopathic pulmonary arterial hypertension (iPAH), which may be related to differences in global and regional RV remodeling and systolic function. We compared RV mechanics in children with PS to those with iPAH, aiming to identify mechanisms and markers of RV dysfunction. Methods Eighteen controls, 18 iPAH and 16 PS patients were retrospectively studied. Age, BSA, and sex distribution were comparable. Two‐dimensional echocardiography, blood flow and tissue Doppler, and longitudinal RV deformation were analyzed. ANCOVA—including RV systolic pressure (RVSP) and length as covariates—was used to compare patient groups. Results RV systolic pressure was higher in iPAH vs PS (96.8±25.4 vs 75.4±18.9 mm Hg, P=.011). Compared to controls, PS patients showed mild dilation (P<.01) and decreased longitudinal deformation (P<.001) at the RV apex. Compared to both PS and controls, iPAH patients showed marked spherical RV dilation (P<.001), reduced global, RV free wall and septal longitudinal deformation (iPAH −22.07%±4.35% vs controls −28.18%±1.69%; −9.98%±4.30% vs −17.45%±2.52%; P<.001) and RV postsystolic shortening (P<.001). RV transverse shortening (radial performance) was increased in PS (31.75%±10.35%; P<.001) but reduced in iPAH (−1.62%±11.11% vs controls 12.00%±7.74%; P<.001). Conclusion Children with iPAH demonstrate adverse global and regional RV remodeling and mechanics compared to those with PS. Mechanisms of RV systolic dysfunction in iPAH include decreased longitudinal deformation, decreased or absent transverse shortening, and postsystolic shortening. These markers may be useful to identify children at risk of RV failure.

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Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort

Cited by 413 publications

References 27 publications

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

The Use of Implantable Cardioverter-defibrillators in the Prevention of Sudden Cardiac Death: A Focus on Congenital Heart Disease and Inherited Arrhythmia Syndromes

Regional right ventricular remodeling and function in children with idiopathic pulmonary arterial hypertension vs those with pulmonary valve stenosis: Insights into mechanics of right ventricular dysfunction

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