Document Detail


Ventricular Arrhythmia Risk Stratification in Patients with Tetralogy of Fallot at the Time of Pulmonary Valve Replacement.
MedLine Citation:
PMID:  25416756     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Most patients with repaired tetralogy of Fallot (TOF) require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remains unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR.
METHODS AND RESULTS: -A retrospective analysis was performed on 205 patients with repaired TOF undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range 25.6 years). Previous ventricular tachycardia (VT) occurred in 16 patients (8%) and 37 (16%) had left ventricular (LV) dysfunction, defined as LV ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including VT, out-of-hospital cardiac arrest, appropriate implantable cardioverter-defibrillator therapy and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95, 90, and 79%, respectively. In the first year following PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of VT and LV dysfunction were associated with higher risk for the combined event (HR 4.7, p=0.004 and HR 0.8, p=0.02 respectively).
CONCLUSIONS: -Patients with repaired TOF undergoing PVR with history of VT and/or LV dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high risk patients, surgical cryoablation does not appear to increase arrhythmic events and may be protective.
Authors:
Anna Sabate Rotes; Heidi M Connolly; Carole A Warnes; Naser M Ammash; Sabrina D Phillips; Joseph A Dearani; Hartzell V Schaff; Harold M Burkhart; David O Hodge; Samuel J Asirvatham; Christopher J McLeod
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-21
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-22     Completed Date:  -     Revised Date:  2014-11-25    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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