From the bedside to the basic science laboratory: Arrhythmias in Fallot's tetralogy

Ross, Bertrand A.

doi:10.1016/0735-1097(93)90396-i

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…1 ' 27 ' 28 Neither was the incidence of sudden death significantly lower than reported in similar previous studies. 1 ' 3 ' 20 Our results suggest that there may be risk factors other than ventricular tachycardia associated with pulmonary regurgitation and dilation of the aortic root. We compared surgical data of patients who died to that of survivors (Table 4).…”

Section: July 2002mentioning

confidence: 72%

“…These factors pose difficulties in analyzing clinical problems and therapies. 20 To identify risk factors in long-term survival, it is important to analyze groups of patients repaired with a uniform approach. One surgeon at the Chiba Cardiovascular Center, Japan, has performed complete repair of tetralogy of Fallot without use of a patch placed across the subpulmonary outflow tract from the right ventricle from 1964 through 1975.…”

mentioning

confidence: 99%

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Influence of early repair of tetralogy of Fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach

et al. 2002

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Pulmonary regurgitation and older age at the time of repair may have a large impact late after repair on subsequent mortality of patients with tetralogy of Fallot. We aimed to identify whether age at repair, and preservation of the pulmonary valve, had a favorable influence on morbidity and mortality. We also analyzed risk factors for late death subsequent to surgical repair. We identified 167 patients who, between 1965 and 1975, and at a mean age of 6 years, underwent total repair of tetralogy of Fallot by a single surgical team without use of an outflow patch. All patients were known to have survived for at least 30 days after repair, and late mortality was identified though the use of hospital records, interviews, and death certificates. The 29-year actuarial survival rate was 86%, with 24 late deaths. Of these deaths, seven occurred suddenly (4.2%). Morbidity was analyzed in 99 of the patients by means of a written questionnaire and telephone interview. It proved possible to analyze ventricular and valvar function in 50 of the patients. Survivors experienced no re-intervention, and 89% of them were in class I of the grading system of the New York Heart Association. We found evidence of 3 episodes of sustained ventricular tachycardia (3.0%), and two episodes of atrial tachycardia (2.0%). Of the 50 patients in whom serial examinations were available, 18 had pulmonary regurgitation of moderate degree or greater, and none had more than moderate tricuspid regurgitation, with a mean QRS duration of 148 ms and an ejection fraction for the left ventricle of 50%. Older age at repair (p = 0.03), and longer periods of cardiac arrest during repair (p = 0.02), were associated with late mortality. Although the mortality was similar to that observed in previous reports, our operative method might have a better effect in terms of late morbidity.

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Section: July 2002mentioning

confidence: 72%

mentioning

confidence: 99%

Influence of early repair of tetralogy of Fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach

et al. 2002

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“…Premature ventricular beats can be detected on Holter monitoring in around 45% of patients 17. Risk factors for asymptomatic ventricular arrhythmias include older age at repair,18 19 increasing time since surgery,20 increased right ventricular pressures, and poor ventricular function 2122 The significance of asymptomatic ventricular arrhythmias is not clear.…”

Section: Discussionmentioning

confidence: 99%

Reduced heart rate variability following repair of tetralogy of Fallot

McLeod

Hillis

Houston

et al. 1999

Heart

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Objective-To examine autonomic function as assessed by heart rate variability in patients 10 or more years after repair of tetralogy of Fallot, and to relate this to cardiac structure, function, and electrocardiographic indices. Methods-Heart rate variability was measured by standard time domain techniques on a 24 hour Holter ECG in 28 patients, aged 12 to 34 years (mean 19.5), who had undergone repair of tetralogy of Fallot at least 10 years previously. Echocardiography was performed to assess left ventricular size and function, right ventricular size and pressure, and any proximal pulmonary arterial stenosis. Right ventricular function was evaluated by radionuclide scan. QRS duration, QT interval, and QT dispersion were measured on a standard 12 lead ECG. Measurements of heart rate variability were compared with values from 28 age matched healthy controls (mean age 19.9 years). Interrelations between variables were assessed using Pearson correlation coeYcients and stepwise regression analysis. Results-Heart rate variability was reduced, compared with values for age matched normal controls, in 12 of the 28 patients. Reduced heart rate variability was associated with increased age, increased right ventricular size and pressure, and widening of the QRS complex. Conclusions-Reduced heart rate variability is a feature following repair of tetralogy of Fallot. It is associated with increasing age, impaired right ventricular haemodynamics, and widening of the QRS complex. Under these circumstances, reduced heart rate variability may be a marker for deteriorating right ventricular function. Increased QRS duration has been identified as a risk factor for sudden death following repair of tetralogy of Fallot, and impaired cardiac autonomic control may be one of the mechanisms involved. (Heart 1999;81:656-660)

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“…These factors demonstrate the difficulty in analyzing risk factors for late mortality. 9 Factors such as demographic variables, surgical methods, techniques of cardiopulmonary bypass, and surgical learning curves, possibly changed between the early 1970s and 1980s. In particular, patching across the ventriculo-pulmonary junction of the right ventricular outflow tract was much more frequent in Japan in the 1980s as opposed to the 1970s.…”

Section: Multicentric Study Selection Of the Years Of Repair: 1972 Anmentioning

confidence: 99%

“…the baseline factors during these studies, due to long periods of enrollment and the wide range of operative techniques, however, could potentially affect eventual outcomes of surgical repair, and make difficult the analysis of risk factors for early and late mortality. 9 There are few reports concerning long-term mortality for large numbers of patients studied as multi-centric cohorts. 10 Our study aims to compare demographics, surgical history, mortality, and risk factors for late death in patients repaired in 1972 and 1982 in a Japanese multicentric study.…”

mentioning

confidence: 99%

Mortality and risk factors for late deaths in tetralogy of Fallot: the Japanese Nationwide Multicentric Survey

et al. 2002

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From the bedside to the basic science laboratory: Arrhythmias in Fallot's tetralogy

Cited by 8 publications

References 28 publications

Influence of early repair of tetralogy of Fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach

Influence of early repair of tetralogy of Fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach

Reduced heart rate variability following repair of tetralogy of Fallot

Mortality and risk factors for late deaths in tetralogy of Fallot: the Japanese Nationwide Multicentric Survey

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