Ventricular Arrhythmias and Sudden Death Following Percutaneous Pulmonary Valve Implantation in Pediatric Patients

Abstract

Reports have suggested a transient increase in ventricular ectopy early after percutaneous pulmonary valve implantation (PPVI). Little is known about the potential for more serious ventricular arrhythmias (VA) in children who undergo PPVI. We sought to evaluate the incidence of severe VA following PPVI in a pediatric population and to explore potential predictive factors. A retrospective cohort study was conducted of patients who underwent PPVI under 20 years of age in our institution from January 2007 to December 2019. The primary outcome of severe VA was defined as sustained and/or hemodynamically unstable ventricular tachycardia (VT), inducible sustained VT, or sudden death of presumed arrhythmic etiology. A total of 21 patients (mean age 16.2 ± 2.1 years; 66.7% male) underwent PPVI. The majority of patients (N = 15; 71.4%) had tetralogy of Fallot (TOF) or TOF-like physiology, with the most common indication being pulmonary insufficiency (N = 10; 47.6%). During a median follow-up of 29.6 months (IQR 10.9–44.0), severe VA occurred in 3 (14.3%) patients aged 15.6 (IQR 14.7–16.1) a median of 12.3 months (IQR 11.2–22.3) after PPVI. All events occurred in patients with TOF-like physiology following Melody valve implant. In conclusion, severe VA can occur long after PPVI in a pediatric population, particularly in those with TOF-like physiology. Further studies are required to elucidate underlying mechanisms and assess strategies to mitigate risks.

Ventricular arrhythmias following balloon‐expandable transcatheter pulmonary valve replacement in the native right ventricular outflow tract

“…While ventricular arrhythmia occurrence is common following TPVR in the nRVOT, our data suggest that this is a benign and transient phenomenon. The periprocedural ventricular arrhythmias evaluated in this study likely have a different mechanism from the late occurring severe ventricular arrhythmias reported recently in this population 11 . Only 61.5% of patients with ventricular arrhythmia were treated.…”

“…8 A recent cohort study reported a late occurrence of severe ventricular arrhythmias following TPVR in this population. 11 This underscores the need for additional pediatric data to inform guidelines and protocols for ventricular arrhythmia surveillance and management following TPVR.…”