BACKGROUND: To determine potential predictors of ventricular tachyarrhythmia and sudden cardiac death (SCD) occurring late after repair of tetralogy of Fallot (TOF). METHODS: Since 1964, 415 patients had undergone total repair for TOF at Niigata University Hospital. Of these, 89 patients who were followed for more than 10 years at our institute were retrospectively reviewed. RESULTS: The mean follow-up period was 24.3 years. During the study period, one patient died of cerebral bleeding, and two patients had SCD. The overall survival rates at 20, 30, and 40 years were 100%, 94.6%, and 94.6%, respectively. Eight (9.0%) patients required re-intervention during the late period associated with right ventricular outflow (n=4), tricuspid valve (n=3), aortic valve (n=2), and others (n=2). Ten (11.2%) patients had a history of ventricular tachycardia (VT) or ventricular fibrillation (VF), and six underwent implantation of an implantable cardiac defibrillator. Multivariate analysis selected the change rate of QRS duration [ms/year; odds ratio (OR), 2.44; 95% confidence interval (CI): 1.28-4.65; P=0.007] and the pressure gradient at tricuspid valve regurgitation on echocardiography (OR, 1.12; 95% CI: 1.02-1.22; P=0.017) as risk factors for VT/VF or SCD. Trans-annular patch (TAP) repair was not an independent risk factor for ventricular arrhythmia. CONCLUSIONS: The combination of rapid change rate of QRS duration and higher-pressure gradient at tricuspid regurgitation were risk factors for ventricular tachyarrhythmia late after TOF repair. Adequate surgical or catheter intervention for pressure and volume load in the right ventricle might decrease the prevalence of VT/VF and SCD.
BACKGROUND: To determine potential predictors of ventricular tachyarrhythmia and sudden cardiac death (SCD) occurring late after repair of tetralogy of Fallot (TOF). METHODS: Since 1964, 415 patients had undergone total repair for TOF at Niigata University Hospital. Of these, 89 patients who were followed for more than 10 years at our institute were retrospectively reviewed. RESULTS: The mean follow-up period was 24.3 years. During the study period, one patient died of cerebral bleeding, and two patients had SCD. The overall survival rates at 20, 30, and 40 years were 100%, 94.6%, and 94.6%, respectively. Eight (9.0%) patients required re-intervention during the late period associated with right ventricular outflow (n=4), tricuspid valve (n=3), aortic valve (n=2), and others (n=2). Ten (11.2%) patients had a history of ventricular tachycardia (VT) or ventricular fibrillation (VF), and six underwent implantation of an implantable cardiac defibrillator. Multivariate analysis selected the change rate of QRS duration [ms/year; odds ratio (OR), 2.44; 95% confidence interval (CI): 1.28-4.65; P=0.007] and the pressure gradient at tricuspid valve regurgitation on echocardiography (OR, 1.12; 95% CI: 1.02-1.22; P=0.017) as risk factors for VT/VF or SCD. Trans-annular patch (TAP) repair was not an independent risk factor for ventricular arrhythmia. CONCLUSIONS: The combination of rapid change rate of QRS duration and higher-pressure gradient at tricuspid regurgitation were risk factors for ventricular tachyarrhythmia late after TOF repair. Adequate surgical or catheter intervention for pressure and volume load in the right ventricle might decrease the prevalence of VT/VF and SCD.
Entities:
Keywords:
QRS change rate; Tetralogy of Fallot (TOF); right ventricular pressure; ventricular arrhythmia
Authors: Byung Won Yoo; Jung Ok Kim; Young Jin Kim; Jae Young Choi; Han Ki Park; Young Hwan Park; Jun Hee Sul Journal: J Thorac Cardiovasc Surg Date: 2012-01-12 Impact factor: 5.209
Authors: A L Knauth; K Gauvreau; A J Powell; M J Landzberg; E P Walsh; J E Lock; P J del Nido; T Geva Journal: Heart Date: 2006-11-29 Impact factor: 5.994
Authors: Zeliha Koyak; Louise Harris; Joris R de Groot; Candice K Silversides; Erwin N Oechslin; Berto J Bouma; Werner Budts; Aeilko H Zwinderman; Isabelle C Van Gelder; Barbara J M Mulder Journal: Circulation Date: 2012-09-18 Impact factor: 29.690
Authors: Jamil A Aboulhosn; Gentian Lluri; Michelle Z Gurvitz; Paul Khairy; François-Pierre Mongeon; Joseph Kay; Anne Marie Valente; Michael G Earing; Alexander R Opotowsky; George Lui; Deborah R Gersony; Stephen Cook; John Child; Jennifer Ting; Gary Webb; Michael Landzberg; Craig S Broberg Journal: Can J Cardiol Date: 2013-01-28 Impact factor: 5.223