Ventricular arrhythmias in postoperative tetralogy of Fallot

Abstract

Ventricular arrhythmias in patients after total surgical repair of tetralogy of Fallot have been associated with late sudden death. In this large multicenter retrospective study of 359 patients with postoperative tetralogy of Fallot, spontaneous ventricular premature complexes (VPCs) on 24-hour ambulatory electrocardiographic monitoring and laboratory-induced ventricular tachycardia (VT) by electrophysiologic stimulation were analyzed. The mean age at surgical repair was 5 years and the mean follow-up duration after repair was 7 years. Spontaneous VPCs on ambulatory monitoring were found in 48% and induced VT on electrophysiologic stimulation was found in 17% of patients. Both spontaneous VPCs and induced VT were significantly related to delayed age at repair, longer follow-up interval, symptoms of syncope or presyncope and right ventricular systolic hypertension (greater than 60 mm Hg) (p less than 0.05), but not to right ventricular diastolic pressure greater than 8 mm Hg. The VPCs on ambulatory monitoring were more complex with increasing age at repair and follow-up duration. Induction of VT on electrophysiologic stimulation correlated with spontaneous VPCs including VT on 24-hour ambulatory electrocardiographic monitoring. The electrophysiologic stimulation protocol varied and the induction of VT increased with a more aggressive stimulation protocol. While induced sustained monomorphic VT was related to all forms of spontaneous VPCs, induced nonsustained polymorphic VT was related to more complex forms of VPCs on ambulatory monitoring. VT was not induced in asymptomatic patients who had normal 24-hour ambulatory electrocardiographic monitoring and normal right ventricular systolic pressure. (ABSTRACT TRUNCATED AT 250 WORDS)

Value of Programmed Ventricular Stimulation After Tetralogy of Fallot Repair

“…In the largest cohort study to date, 5 independent predictors of clinical VT were QRS Ն180 ms and annual increase in QRS duration. Additional risk factors for SCD have included older age at repair, presence of a transannular right ventricular outflow tract patch, frequent ectopic beats, 20,21 increased right ventricular systolic pressures, 19,22,23 complete heart block, 19,24 and increased JT dispersion. 25,26 Despite advances in noninvasive risk stratification, identification of high-risk subgroups has not been sufficiently accurate to guide management decisions reliably.…”

Rehabilitation of a Female Patient after Corrective Surgery for Tetralogy of Fallot

“…The leading cause of mortality of patients after surgical correction of TOF is sudden cardiac death caused by ventricular arrhythmias of persistent ventricular tachycardia type (4, 7). The risk factors for ventricular arrhythmias are older age at the time of surgery, increased pressure in the right ventricle, Acta facultatis medicae Naissensis 2015;32(4):293-299 (8,9). A late complication in patients after surgical correction of TOF is pulmonary regurgitation, which is the leading cause of dilatation of the right ventricle, stress intolerance, arrhythmias and sudden cardiac death (10,11) .…”

National Russian Guidelines on Application of the Methods of Holter Monitoring in Clinical Practice

“…Напротив, хорошо известно, что сложные восстано-вительные операции с остаточными нарушениями гемодинамики сопряжены с частыми приступами предсердных и желудочковых аритмий [495,496]. Хотя значение аритмий у этих пациентов остается противоречивым, желудочковые нарушения ритма высоких градаций в сочетании с желудочковой дис-функцией являются, по-видимому, показателем для выявления детей с увеличенным риском ВС [497,498]. Сложные аритмии, выявленные при ХМ, могут указывать на необходимость дальнейшего обследова-ния, даже при отсутствии явных симптомов [499].…”