Impact of surgery on presence and dimensions of anatomical isthmuses in tetralogy of Fallot

Kapel, Gijsbert F.L.; Laranjo, Sérgio; Blom, Nico A.; Hazekamp, Mark G.; Schalij, Martin J.; Bartelings, Margot M.; Jongbloed, Monique R.M.; Zeppenfeld, Katja

doi:10.1136/heartjnl-2017-312452

Cited by 19 publications

(6 citation statements)

References 13 publications

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“…Substrate formation might depend on the coincidence of pathological myocardial remodeling and anatomical boundaries determined by the type and timing of prior corrective surgery. Changes in surgical approaches over the past decades (eg, a combined transatrial-transpulmonary approach avoiding ventriculotomies in tetralogy of Fallot) are likely to affect the incidence and the potential substrate for arrhythmias ( S9.11.3.16 ). Therefore, knowledge of the malformation and careful review of all operation records before ablation is important.…”

Section: Mapping and Ablationmentioning

confidence: 99%

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

et al. 2020

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Representative of the European Heart Rhythm Association (EHRA) †Representative of the American College of Cardiology (ACC) ‡Representative of the Sociedade Brasileira de Arritmias Cardíacas (SOBRAC) xRepresentative of the American Heart Association (AHA) {Representative of the Latin American Heart Rhythm Society (LAHRS) #Representative of the Asia Pacific Heart Rhythm Society (APHRS) **Representative of the Japanese Heart Rhythm Society (JHRS) † †Representative of the Pediatric and Congenital Electrophysiology Society (PACES)

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Section: Mapping and Ablationmentioning

confidence: 99%

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

et al. 2020

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“…24 Furthermore, approaches during corrective surgery for TOF that limit the number of potential critical isthmuses for VT (eg, transatrial-transpulmonary approach) should be favored whenever feasible because they may reduce future risks of developing VAs. 25…”

Section: Discussionmentioning

confidence: 99%

Systematic Electrophysiological Study Prior to Pulmonary Valve Replacement in Tetralogy of Fallot: A Prospective Multicenter Study

Waldmann

Bessière

Gardey

et al. 2023

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: Ventricular arrhythmias and sudden death are recognized complications in tetralogy of Fallot. Electrophysiological studies (EPS) before pulmonary valve replacement (PVR), the most common reintervention in tetralogy of Fallot, could potentially inform therapy to improve arrhythmic outcomes. METHODS: A prospective multicenter study was conducted to systematically assess EPS with programmed ventricular stimulation in patients with tetralogy of Fallot referred for PVR from January 2020 to December 2021. A standardized stimulation protocol was used across all centers. RESULTS: A total of 120 patients were enrolled, mean age 39.2±14.5 years, 53.3% males. Sustained ventricular tachycardia was induced in 27 (22.5%) patients. When identifiable, the critical isthmus most commonly implicated (ie, in 90.0%) was between the ventricular septal defect patch and pulmonary annulus. Factors independently associated with inducible ventricular tachycardia were history of atrial arrhythmia (OR, 8.56 [95% CI, 2.43–34.73]) and pulmonary annulus diameter >26 mm (OR, 5.05 [95% CI, 1.47–21.69]). The EPS led to a substantial change in management in 23 (19.2%) cases: 18 (15.0%) had catheter ablation, 3 (2.5%) surgical cryoablation during PVR, and 9 (7.5%) defibrillator implantation. Repeat EPS 5.1 (4.8–6.2) months after PVR was negative in 8 of 9 (88.9%) patients. No patient experienced a sustained ventricular arrhythmia during 13 (6.1–20.1) months of follow-up. CONCLUSIONS: Systematically performing programmed ventricular stimulation in patients with tetralogy of Fallot referred for PVR yields a high rate of inducible ventricular tachycardia and carries the potential to alter management. It remains to be determined whether a standardized treatment approach based on the results of EPS will translate into improved outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04205461

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“…41 A transatrial/transpulmonary repair or a transannular repair eliminates isthmus 2. 40,41 In patients who do not have a ventriculotomy isthmus (isthmus 2), both isthmuses 1 and 3 are involved in the reentry circuit. Because isthmus 1 is often broad and difficult to transect by catheter ablation, isthmus 3 may serve as a preferred ablation targets for this circuit.…”

Section: Ventricular Arrhythmiasmentioning

confidence: 99%

Arrhythmias in Repaired Tetralogy of Fallot: A Scientific Statement From the American Heart Association

Krieger¹,

Zeppenfeld²,

DeWitt³

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Arrhythmia and sudden cardiac death remain common in repaired tetralogy of Fallot and affect even those with excellent anatomic repairs. Atrial arrhythmia often has mechanisms different from those in acquired heart disease. Ventricular arrhythmia remains a major source of mortality in repaired tetralogy of Fallot. Noninvasive risk stratification is important to identify patients who may benefit from ablation or primary prevention implantable cardioverter defibrillators. Multiple noninvasive risk factors are associated with ventricular arrhythmia, but no universally accepted risk stratification algorithm exists. The mechanism of ventricular arrhythmia is usually attributable to a consistent and discrete set of slowly conducting anatomic isthmuses related to both the native anatomy and the consequences of the surgical repair, which interact with ventricular remodeling to provide arrhythmic substrate. This substrate can be identified during electroanatomic mapping and prophylactically ablated in appropriate patients. This scientific statement discusses the mechanisms and treatment of arrhythmia in repaired tetralogy of Fallot.

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Impact of surgery on presence and dimensions of anatomical isthmuses in tetralogy of Fallot

Cited by 19 publications

References 13 publications

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

Systematic Electrophysiological Study Prior to Pulmonary Valve Replacement in Tetralogy of Fallot: A Prospective Multicenter Study

Arrhythmias in Repaired Tetralogy of Fallot: A Scientific Statement From the American Heart Association

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