Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot
Open accessAbstract
Objectives We sought to determine the features associated with sustained monoform ventricular tachycardia (VT) in adult patients late after repair of tetralogy of Fallot (TOF) and to review their management.Background Patients with repair of TOF are at risk for sudden death. Risk factors for ventricular arrhythmia have been identified from patients with ventricular ectopic beats because of the low prevalence of sustained VT.Methods From a retrospective chart review of patients assessed between January 1990 and December 1994, 18 adult patients with VT were identified and compared with 192 with repaired TOF free of sustained arrhythmia.Results There was no significant difference in age at repair, age at follow-up or operative history. Patients with VT had frequent ventricular ectopic beats (6 of 9 vs. 21 of 101), low cardiac index ([mean +/- SD] 2.4 +/- 0.4 vs. 3.0 +/- 0.8) and more structural abnormalities of the right ventricle (outflow tract aneurysms and pulmonary or tricuspid regurgitation) than control patients. Electrophysiologic map-guided operation was performed in 10 of 14 patients who required reoperation. VT has reoccurred in three of these patients. Four patients did not undergo operation (three received amiodarone; one underwent defibrillator implantation). Two patients with VT also had severe heart failure and died.Conclusions Most patients with VT late after repair of TOF have outflow tract aneurysms or pulmonary regurgitation, or both. These patients have a greater frequency of ventricular ectopic beats than arrhythmia-free patients after repair of TOF. A combined approach of correcting significant structural abnormalities (pulmonary valve replacement or right ventricular aneurysmectomy, or both) with intraoperative electrophysiologic-guided ablation may reduce the potential risk of deterioration in ventricular function and enable arrhythmia management to be optimized.
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Right bundle branch block is present during sinus rhythm in the majority of patients, and may cause differential diagnostic difficulties requiring electrophysiology testing for a correct diagnosis.
“Right bundle branch block is present during sinus rhythm in the majority of patients, and may cause differential diagnostic difficulties requiring electrophysiology testing for a correct diagnosis.390”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [390]
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- Authors
- Harrison, D. A., Harris, L., Siu, S. C., MacLoghlin, C. J., Connelly, M. S., Webb, G. D., Downar, E., McLaughlin, P. R., & Williams, W. G.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Harris, Louise
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1997-11
- Volume
- 30
- Issue
- 5
- Pages
- 1368-1373
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2083076536
- Cited by
- 277
- References
- 28
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 9 · 2019: 5 · 2018: 12 · 2017: 12 · 2016: 9 · 2015: 7 · 2014: 15 · 2013: 19 · 2012: 13
- FWCI
- 5.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- sustained ventricular tachycardia, tetralogy of Fallot, repaired congenital heart disease, premature ventricular contractions, right ventricular outflow tract aneurysm, pulmonary regurgitation, tricuspid regurgitation, cardiac index, pulmonary valve replacement, aneurysm resection, amiodarone, implantable cardioverter-defibrillator, sudden cardiac death
- MeSH terms
- Adult, Coronary Aneurysm, Female, Hemodynamics, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Factors, Tetralogy of Fallot, Time Factors, Treatment Outcome, Tachycardia, Ventricular
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