Prevention of sudden cardiac death in patients with Tetralogy of Fallot: Risk assessment and long term outcome

Probst, Julia; Diller, Gerhard‐Paul; Reinecke, Holger; Leitz, Patrick; Frommeyer, Gerrit; Orwat, Stefan; Vormbrock, Julia; Radke, Robert; Alba, F. De Torres; Kaleschke, Gerrit; Baumgartner, Helmut; Eckardt, Lars; Wasmer, Kristina

doi:10.1016/j.ijcard.2018.06.107

Cited by 16 publications

(5 citation statements)

References 23 publications

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“…Sudden death is the second most frequent cause for mortality in ACHD (41). However, compared to non-ACHD, the risk assessment for ventricular tachycardia in ACHD is still difficult due to the limited number of patients (73,74). Patients with Eisenmenger syndrome, systemic right ventricle, or functionally single ventricle seem to exhibit a higher risk for sudden death with up to 5 deaths/1,000 patient-years (75).…”

Section: Increasing Importance Of Electrophysiologymentioning

confidence: 99%

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Hörer

2018

Cardiovasc. Diagn. Ther

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Today, more than two thirds of patients with congenital heart disease (CHD) are adults. Cardiac surgery plays an essential role in restoring and maintaining cardiac function, aside from evolving medical treatment and catheter-based interventions. The aim of the present publication was to describe the spectrum of operations performed on adults with CHD (ACHD) by reviewing current literature. Currently, surgery for ACHD is predominantly valve surgery, since valvular pathologies are often either a part of the basic heart defect or develop as sequelae of corrective or palliative surgery. Surgical techniques for valve repair, established in patients with acquired heart disease (non-ACHD), can often be transferred to ACHD. New valve substitutes may help to reduce the number of redo operations. Most of valve operations yield good results in terms of survival and quality of life, with the precondition that the ventricular function is preserved. Heart failure due to end-stage CHD is the most frequent cause of mortality in ACHD. However, surgical treatment by means of mechanical circulatory support (MCS) is still uncommon and the mortality exceeds the one following other operations in ACHD. Currently, different devices are used and new technical developments are in progress. However, there still is no ideal assist device available. Therefore, heart transplantation remains the only valid option for end-stage CHD. Despite higher early mortality following heart transplantation in ACHD compared to non-ACHD, the long-term survival compares favorably to non-ACHD. There is room for improvement by refining the indications, the time of listing, and the perioperative care of ACHD transplant patients. Sudden death is the second most frequent cause of mortality in ACHD. Ventricular tachycardia is the most frequent cause of sudden death followed by coronary artery anomaly. Due to the increasing awareness of physicians and the improved imaging techniques, coronary artery anomalies are coming more into the focus of cardiac surgeons. However, the reported experience is limited and it is currently difficult to provide a standardized and generally applicable recommendation for the indication and the adequate surgical technique. With the increasing age and complexity of ACHD, treatment of rhythm disturbances by surgical ablation, pacemaker or implantable cardioverter defibrillator (ICD) implantation and resynchronisation gains importance. A risk score specifically designed for surgery in ACHD is among the newest developments in predicting the outcome of surgical treatment of ACHD. This evidence-based score, derived from and validated with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database, enables comparison of risk-adjusted performance of the whole spectrum of procedures performed in ACHD and helps in understanding the differences in surgical outcomes. The score is thus a powerful tool for quality control and quality improvement. In conclusion, new developments in surgery for ACHD are currently made with regard to ...

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Section: Increasing Importance Of Electrophysiologymentioning

confidence: 99%

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Hörer

2018

Cardiovasc. Diagn. Ther

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“…Additionally, the conducting properties of anatomic isthmuses in monomorphic VT help estimate the risk of subsequent VT, discussed further in the ablation section. In our center, a diagnostic EPS is used for risk stratification on sudden death based on the point score outlined by Khairy et al [9,10].…”

Section: Lesion: Tetralogy Of Fallotmentioning

confidence: 99%

Treatment of arrhythmia disorders in the adult with congenital heart disease: A lesion-specific review

Knijnik

Lloyd

2022

Kardiol Pol

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There are now more adults living with a history of congenital heart disease than there are children. Modern electrophysiologists must familiarize themselves with the most common congenital lesions requiring electrophysiologic care as adults. Advancements in this field have been made most notably with high-resolution 3D imaging and electroanatomic mapping, left ventricular cannulation techniques, alternative pacing strategies, intracardiac echo, and transeptal access tools.

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“…Electrophysiology study and ablation prior to interventional valve replacement and intraoperative surgical treatment of the isthmus is therefore recommended by current guidelines (32). Most patients will be implanted with a defibrillator even after successful catheter ablation to prevent SCD although at least in theory catheter ablation may be curative in this patient cohort (54).…”

Section: Catheter Ablationmentioning

confidence: 99%

Therapy of supraventricular and ventricular arrhythmias in adults with congenital heart disease—narrative review

Wasmer¹,

Eckardt²,

Baumgartner³

et al. 2021

Cardiovasc Diagn Ther

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Arrhythmias are among the most common late complications in adults with congenital heart disease (ACHD) and a frequent reason for hospital admission. Both, supraventricular and ventricular arrhythmias, not only cause debilitating symptoms, but may be life-threatening by increasing risk of stroke, causing or worsening heart failure and being associated with sudden death. Substrate and risk for arrhythmia differs widely between congenital defects with specific arrhythmias being much more common in some patients than others. Atrial macroreentrant arrhythmias are particularly frequent in patients with atrial septal defects and repair that involves atrial incisions including patients with transposition of the great arteries (TGA) and atrial switch. Accessory pathways and related arrhythmias are often associated with Ebstein's anomaly and congenitally corrected TGA. Monomorphic ventricular arrhythmias occur in patients with ventricular incisions, namely patients with Tetralogy of Fallot. Changes in surgical repair techniques influence arrhythmia prevalence and substrate as well as anatomical access for catheter ablation procedures.In addition, epidemiologic changes associated with improved long-term survival will further increase the prevalence of atrial fibrillation in ACHD. This article summarizes current understanding of prevalence of specific arrhythmias, underlying mechanisms, medical and interventional treatment options and their outcome in ACHD.

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Prevention of sudden cardiac death in patients with Tetralogy of Fallot: Risk assessment and long term outcome

Cited by 16 publications

References 23 publications

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Treatment of arrhythmia disorders in the adult with congenital heart disease: A lesion-specific review

Therapy of supraventricular and ventricular arrhythmias in adults with congenital heart disease—narrative review

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