Long-Term Electrocardiographic Follow-Up after Repair of Tetralogy of Fallot

Abstract

Progressive conduction disorders are noted during long-term follow-up in Fallot patients who received transannular patch but also in those who received no patch or a pulmonary homograft. It suggests that volume overloading related to the transannular patch but also pressure overloading and myocardial injury related to surgery contribute to their development.

QRS Complex Enlargement as a Predictor of Ventricular Arrhythmias in Patients Affected by Surgically Treated Tetralogy of Fallot: A Comprehensive Literature Review and Historical Overview

“…These results further underline the involvement of depolarization abnormalities in arrhythmogenesis in postrepair Fallot patients [48]. This issue has indeed been observed both in patients receiving transannular patch, as well as in those who received no patch or a pulmonary homograft [49]. Furthermore additional ECG parameters, including increased QT, signal-averaging ECG, microvolt T wave alternans, and JT dispersions, combined with a QRS ≥ 180 ms, refine risk stratification for ventricular tachycardia in these patients, thus suggesting that both depolarization and repolarization abnormalities are associated with ventricular tachycardia after surgical repair of TOF.…”

QRS Duration During Follow-Up of Tetralogy of Fallot: How Valuable is it? Analysis of ECG Changes in Relation to Pulmonary Valve Implantation

“…Maladaptive RV remodeling by pressure and volume overload, induced through chronic pulmonary regurgitation after RVOT reconstruction, remains the principal culprit [15]. This is electrophysiologically represented by QRS prolongation [16,17], as a result of surgical scarring combined with progressive RV dilation. Until now, a QRS > 180 ms is considered as a risk factor for sudden cardiac death [18] remaining a major criterium for an implantable cardiac defibrillator (ICD) in primary prevention [19] and still a valid risk factor adopted in the recently published 2020 ESC guidelines for adult congenital heart disease [20].…”

Use of a Dacron Annular Sparing Versus Limited Transannular Patch With Nominal Pulmonary Annular Expansion in Infants With Tetralogy of Fallot

“…(Ann Thorac Surg 2017;103:186-92) Ó 2017 by The Society of Thoracic Surgeons O bligatory pulmonary insufficiency (PI) following repair of tetralogy of Fallot (ToF) using a traditional transannular patch has been associated with right ventricular (RV) dilatation, progressive RV and left ventricular dysfunction, cardiac arrhythmias, and sudden death [1][2][3][4]. As a result of the intermediate-and long-term consequences following a right ventriculotomy crossing the pulmonary valve annulus, many surgeons have moved toward an infundibular sparing approach [5].…”