Francis Bessière1, Kévin Gardey1, Abdeslam Bouzeman2, Guillaume Duthoit3, Linda Koutbi4, Fabien Labombarda5, Christelle Marquié6, Jean Baptiste Gourraud7, Pierre Mondoly8, Jean Marc Sellal9, Pierre Bordachar10, Alexis Hermida11, Frédéric Anselme12, Anouk Asselin13, Caroline Audinet14, Yvette Bernard15, Serge Boveda16, Philippe Chevalier1, Gael Clerici17, Antoine da Costa18, Maxime de Guillebon19, Pascal Defaye20, Romain Eschalier21, Rodrigue Garcia22, Charles Guenancia23, Benoit Guy-Moyat24, Roland Henaine1, Didier Irles25, Laurence Iserin26, François Jourda27, Magalie Ladouceur28, Philippe Lagrange29, Mikael Laredo3, Jacques Mansourati30, Grégoire Massoulié21, Amel Mathiron11, Philippe Maury8, Cédric Nguyen31, Sandro Ninni6, Marie-Cécile Perier13, Bertrand Pierre32, Frédéric Sacher10, Camille Walton1, Pierre Winum33, Raphaël Martins34, Jean Luc Pasquié35, Jean Benoit Thambo10, Xavier Jouven36, Nicolas Combes37, Sylvie Di Filippo1, Eloi Marijon38, Victor Waldmann39. 1. Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France. 2. Parly II Private Hospital, Le Chesnay, France. 3. La Pitié-Salpêtrière University Hospital, Paris, France. 4. La Timone Hospital, Marseille, France. 5. Caen University Hospital, Caen, France. 6. Lille University Hospital, Lille, France. 7. Nantes University Hospital, Nantes, France. 8. Toulouse University Hospital, Toulouse, France. 9. Nancy University Hospital, Nancy, France. 10. Bordeaux University Hospital, Bordeaux, France. 11. Amiens University Hospital, Amiens, France. 12. Rouen University Hospital, Rouen, France. 13. Université de Paris, PARCC, INSERM, Paris, France. 14. Bretagne Sud Hospital, Lorient, France. 15. Besançon University Hospital, Besançon, France. 16. Pasteur Clinic, Toulouse, France. 17. Saint Pierre University Hospital, La Réunion, France. 18. Saint Etienne University Hospital, Saint Etienne, France. 19. Pau Hospital, Pau, France. 20. Grenoble University Hospital, Grenoble, France. 21. Clermont-Ferrand University Hospital, Clermont-Ferrand, France. 22. Poitiers University Hospital, Poitiers, France. 23. Dijon University Hospital, Dijon, France. 24. Limoges University Hospital, Limoges, France. 25. Annecy Hospital, Annecy, France. 26. Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France. 27. Auxerre Hospital, Auxerre, France. 28. Université de Paris, PARCC, INSERM, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France. 29. Saint-Pierre Clinic, Perpignan, France. 30. Brest University Hospital, Brest, France. 31. Chalon sur Saône Hospital, Chalon sur Saône, France. 32. Tours University Hospital, Tours, France. 33. Nîmes University Hospital, Nîmes, France. 34. Rennes University Hospital, Rennes, France. 35. Montpellier University Hospital, Montpellier, France. 36. Université de Paris, PARCC, INSERM, Paris, France; Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France. 37. Université de Paris, PARCC, INSERM, Paris, France; Pasteur Clinic, Toulouse, France. 38. Université de Paris, PARCC, INSERM, Paris, France; Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France. Electronic address: https://twitter.com/EloiMarijon. 39. Université de Paris, PARCC, INSERM, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France. Electronic address: victor.waldmann@gmail.com.
Abstract
OBJECTIVES: This study aimed to assess the impact of pulmonary valve replacement (PVR) on ventricular arrhythmias burden in a population of tetralogy of Fallot (TOF) patients with continuous cardiac monitoring by implantable cardioverter-defibrillators (ICDs). BACKGROUND: Sudden cardiac death is a major cause of death in TOF, and right ventricular overload is commonly considered to be a potential trigger for ventricular arrhythmias. METHODS: Data were analyzed from a nationwide French ongoing study (DAI-T4F) including all TOF patients with an ICD since 2000. Survival data with recurrent events were used to compare the burden of appropriate ICD therapies before and after PVR in patients who underwent PVR over the study period. RESULTS: A total of 165 patients (mean age 42.2 ± 13.3 years, 70.1% male) were included from 40 centers. Over a median follow-up period of 6.8 (interquartile range: 2.5 to 11.4) years, 26 patients (15.8%) underwent PVR. Among those patients, 18 (69.2%) experienced at least 1 appropriate ICD therapy. When considering all ICD therapies delivered before (n = 62) and after (n = 16) PVR, the burden of appropriate ICD therapies was significantly lower after PVR (HR: 0.21; 95% confidence interval [CI]: 0.08 to 0.56; p = 0.002). Respective appropriate ICD therapies rates per 100 person-years were 44.0 (95% CI: 35.7 to 52.5) before and 13.2 (95% CI: 7.7 to 20.5) after PVR (p < 0.001). In the overall cohort, PVR before ICD implantation was also independently associated with a lower risk of appropriate ICD therapy in primary prevention patients (HR: 0.29 [95% CI: 0.10 to 0.89]; p = 0.031). CONCLUSIONS: In this cohort of high-risk TOF patients implanted with an ICD, the burden of appropriate ICD therapies was significantly reduced after PVR. While optimal indications and timing for PVR are debated, these findings suggest the importance of considering ventricular arrhythmias in the overall decision-making process. (French National Registry of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator [DAI-T4F]; NCT03837574).
OBJECTIVES: This study aimed to assess the impact of pulmonary valve replacement (PVR) on ventricular arrhythmias burden in a population of tetralogy of Fallot (TOF) patients with continuous cardiac monitoring by implantable cardioverter-defibrillators (ICDs). BACKGROUND: Sudden cardiac death is a major cause of death in TOF, and right ventricular overload is commonly considered to be a potential trigger for ventricular arrhythmias. METHODS: Data were analyzed from a nationwide French ongoing study (DAI-T4F) including all TOF patients with an ICD since 2000. Survival data with recurrent events were used to compare the burden of appropriate ICD therapies before and after PVR in patients who underwent PVR over the study period. RESULTS: A total of 165 patients (mean age 42.2 ± 13.3 years, 70.1% male) were included from 40 centers. Over a median follow-up period of 6.8 (interquartile range: 2.5 to 11.4) years, 26 patients (15.8%) underwent PVR. Among those patients, 18 (69.2%) experienced at least 1 appropriate ICD therapy. When considering all ICD therapies delivered before (n = 62) and after (n = 16) PVR, the burden of appropriate ICD therapies was significantly lower after PVR (HR: 0.21; 95% confidence interval [CI]: 0.08 to 0.56; p = 0.002). Respective appropriate ICD therapies rates per 100 person-years were 44.0 (95% CI: 35.7 to 52.5) before and 13.2 (95% CI: 7.7 to 20.5) after PVR (p < 0.001). In the overall cohort, PVR before ICD implantation was also independently associated with a lower risk of appropriate ICD therapy in primary prevention patients (HR: 0.29 [95% CI: 0.10 to 0.89]; p = 0.031). CONCLUSIONS: In this cohort of high-risk TOF patients implanted with an ICD, the burden of appropriate ICD therapies was significantly reduced after PVR. While optimal indications and timing for PVR are debated, these findings suggest the importance of considering ventricular arrhythmias in the overall decision-making process. (French National Registry of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator [DAI-T4F]; NCT03837574).