The roles of chronic pressure and volume overload states in induction of arrhythmias: An animal model of physiologic sequelae after repair of tetralogy of Fallot

Zeltser, Ilana; Gaynor, J. William; Petko, Matus; Myung, Richard J.; Birbach, Mariusz; Waibel, Robert; Ittenbach, Richard F.; Tanel, Ronn E.; Vetter, Victoria L.; Rhodes, Larry A.

doi:10.1016/j.jtcvs.2005.08.034

Cited by 40 publications

(34 citation statements)

References 30 publications

(47 reference statements)

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“…These indices may reflect chronic right ventricular volume overload, which has been associated with an increased incidence of right-sided atrial arrhythmias. 19 The high rate of inappropriate ICD shocks consistently reported in patients with congenital heart disease likely reflects the relatively young age of the study population, the propensity for coexisting supraventricular tachyarrhythmias, and the higher susceptibility for lead failure. 20 Indeed, 21% of patients experienced late lead-related complications.…”

Section: Discussionmentioning

confidence: 94%

Implantable Cardioverter-Defibrillators in Tetralogy of Fallot

et al. 2008

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Background-Tetralogy of Fallot is the most common form of congenital heart disease in implantable cardioverterdefibrillator (ICD) recipients, yet little is known about the value of ICDs in this patient population. Methods and Results-We conducted a multicenter cohort study in high-risk patients with Tetralogy of Fallot to determine actuarial rates of ICD discharges, identify risk factors, and characterize ICD-related complications. A total of 121 patients (median age 33.3 years; 59.5% male) were enrolled from 11 sites and followed up for a median of 3.7 years. ICDs were implanted for primary prevention in 68 patients (56.2%) and for secondary prevention in 53 (43.8%), defined by clinical sustained ventricular tachyarrhythmia or resuscitated sudden death. Overall, 37 patients (30.6%) received at least 1 appropriate and effective ICD discharge, with a median ventricular tachyarrhythmia rate of 213 bpm. Annual actuarial rates of appropriate ICD shocks were 7.7% and 9.8% in primary and secondary prevention, respectively (Pϭ0.11). A higher left ventricular end-diastolic pressure (hazard ratio 1.3 per mm Hg, Pϭ0.004) and nonsustained ventricular tachycardia (hazard ratio 3.7, Pϭ0.023) independently predicted appropriate ICD shocks in primary prevention. Inappropriate shocks occurred in 5.8% of patients yearly. Additionally, 36 patients (29.8%) experienced complications, of which 6 (5.0%) were acute, 25 (20.7%) were late lead-related, and 7 (5.8%) were late generator-related complications. Nine patients died during follow-up, which corresponds to an actuarial annual mortality rate of 2.2%, which did not differ between the primary and secondary prevention groups. Conclusions-Patients with tetralogy of Fallot and ICDs for primary and secondary prevention experience high rates of appropriate and effective shocks; however, inappropriate shocks and late lead-related complications are common.

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Section: Discussionmentioning

confidence: 94%

Implantable Cardioverter-Defibrillators in Tetralogy of Fallot

et al. 2008

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“…There have been several animal models proposed to simulate the pathophysiological change of repaired TOF patients (7)(8)(9)(10)(11). Most of these animal models involve pulmonary valvotomy or stenting of the RVOT to create PR (7,8).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several animal models have been proposed to simulate the hemodynamic changes in repaired TOF patients by using pulmonary valvotomy or transannular patch (7)(8)(9)(10)(11). Although effective in hemodynamic simulation, the importance of electrophysiological factor was seldom addressed.…”

mentioning

confidence: 99%

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Chiu

Huang

Chang³

et al. 2011

Pediatr Res

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Pulmonary regurgitation and prolonged QRS duration of right bundle branch (RBB) block are common in repaired tetralogy of Fallot (TOF) and increase the risk of sudden death. We sought to establish an animal model to reflect both abnormalities. Twenty-one canines: group I (n ϭ 7) received a surgical right ventricular outflow tract (RVOT) transannular patch plus pulmonary valve destruction; group II (n ϭ 5) received RBB ablation and sham operation; and group III (n ϭ 9) received combined interventions. Serial electrophysiological data were obtained up to 1 y. Procedure mortality was 27.6%. At 1 y, although severe pulmonary regurgitation was documented in most dogs in groups I (71%) and III (100%), progressive RVOT dilatation was noted in group III. RBB block was present in all dogs in groups II and III. However, the increments of QRS duration, QTc, JTc, and QT dispersion progression between 1 mo and 1 y were all greatest in group III. Ventricular arrhythmia events were frequent in group III (median 3.3/mo) but uncommon in groups I and II (median 1/mo). We have created a novel animal model that adequately reflects both the hemodynamic and electrophysiological characteristics of repaired TOF patients and can be applied to examine the risk of ventricular arrhythmias. (Pediatr Res 70: 247-252, 2011) W ith the advances in cardiac interventions, most patients with tetralogy of Fallot (TOF) can survive into adulthood. Long-term follow-up, however, has revealed that these patients are at risk of ventricular arrhythmia and sudden cardiac death (1). Patients with repaired TOF commonly have complete right bundle branch block (RBBB), detected by surface electrocardiography (EKG) with prolonged QRS duration (2). This complication is related to the patch repair of the ventricular septal defect and the right ventricular outflow tract (RVOT) incision to relieve RVOT obstruction. Risk factors for ventricular arrhythmia disclosed in previous studies include hemodynamic factors such as severe pulmonary regurgitation (PR) and increased left ventricle end-diastolic pressure and electrophysiologic factors such as prolonged QRS duration (3,4). The possible mechanism includes a mechanoelectrical interaction that PR could increase right ventricular loading, which further aggravates QRS prolongation (5). Thus, the depolarization and repolarization inhomogeneity and secondary QT prolongation contribute to the development of ventricular arrhythmia. However, the interaction is complex and difficult to elucidate (6).Recently, several animal models have been proposed to simulate the hemodynamic changes in repaired TOF patients by using pulmonary valvotomy or transannular patch (7-11). Although effective in hemodynamic simulation, the importance of electrophysiological factor was seldom addressed. Thus, these models may not adequately represent the whole clinical scenario of repaired TOF. We therefore created a novel animal model in which RVOT transannular patch, PR creation, and RBBB by radiofrequency ablation would all be present to ...

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“…In animal models that reproduced different physiologic states following TOF repair, those animals with chronic RV volume overload resulting from pulmonary valvotomy were significantly more likely to develop sustained atrial arrhythmias (p=0.01) [16]. Patients with atrial tachycardia have been reported to have significantly larger mean right atrial dimensions and volume compared to age-matched patients without arrhythmias [17]. Tissue Doppler imaging assessment of RV diastolic function has suggested reduced early RV diastolic velocity is significantly reduced in TOF patients that develop atrial arrhythmias [18].…”

Section: Arrhythmia Substratementioning

confidence: 99%

Arrhythmia Susceptibility and Management in Adult Patients with Repaired Tetralogy of Fallot

Zubairi¹

2011

J Clinic Experiment Cardiol

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Tetralogy of Fallot is the most common cyanotic congenital valvular heart lesion. Successful neonatal repair has lead to improved survival into and through adulthood. Severe pulmonary regurgitation occurs as a consequence of surgical repair, resulting in right ventricular volume overload, tricuspid regurgitation, and atrial and ventricular scarring and fibrosis. Repair also involves atriotomy and ventriculotomy, as well as the placement of patch material. These interventions contribute to an increased arrhythmia burden in these patients. Management strategies are variably successful and include pharmacotherapy, catheter ablation, device implantation, and pulmonary valve replacement.

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The roles of chronic pressure and volume overload states in induction of arrhythmias: An animal model of physiologic sequelae after repair of tetralogy of Fallot

Abstract: Chronic right ventricular volume overload resulted in an increased incidence of inducible ventricular and atrial arrhythmias.

Cited by 40 publications

References 30 publications

Implantable Cardioverter-Defibrillators in Tetralogy of Fallot

Implantable Cardioverter-Defibrillators in Tetralogy of Fallot

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Arrhythmia Susceptibility and Management in Adult Patients with Repaired Tetralogy of Fallot

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