Arrhythmias After Tetralogy of Fallot Repair

Folino, Antonio Franco and Daliento, Luciano (2005) Arrhythmias After Tetralogy of Fallot Repair. [Journal (Paginated)]

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Tetralogy of Fallot is the most common cyanotic congenital heart disease, with a good outcome after total surgical correction. In spite of a low perioperative mortality and a good quality of life, late sudden death remains a significant clinical problem, mainly related to episodes of sustained ventricular tachycardia and ventricular fibrillation. Fibro-fatty substitution around infundibular resection, intraventricular septal scar, and patchy myocardial fibrosis, may provide anatomical substrates of abnormal depolarization and repolarization causing reentrant ventricular arrhythmias. Several non-invasive indices based on classical examination such as ECG, signal-averaging ECG, and echocardiography have been proposed to identify patients at high risk of sudden death, with hopeful results. In the last years other more sophisticated invasive and non-invasive tools, such as heart rate variability, electroanatomic mapping and cardiac magnetic resonance added a relevant contribution to risk stratification. Even if each method per se is affected by some limitations, a comprehensive multifactorial clinical and investigative examination can provide an accurate risk evaluation for every patient

Item Type:Journal (Paginated)
Keywords:Tetralogy of Fallot, surgery; ventricular arrhythmias; risk stratification
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4598
Deposited By:Indian Pacing and Electrophysiology, Journal
Deposited On:12 Nov 2005
Last Modified:11 Mar 2011 08:56

References in Article

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1. Lillehei CW, Cohen M, Warden HE. Direct vision intracardiac surgical correction of the tetralogy of Fallot, pentalogy of Fallot and pulmonary atresia defects: report of first ten cases. Ann Surg 1955; 142: 418.

2. Starnes VA, Luciani GB, Latter SA, Griffin ML. Current surgical management of tetralogy of Fallot. Ann Thorac Surg 1994; 58: 211-215.

3. Norgaard MA, Lauridsen P, Helvind M, Petterson G. Twenty-to-thirty-seven-year follow-up after repair for tetralogy of Fallot. Eur J Cardiothorac surg 1999;16:125-130.

4. Hamada H, Terai M, Jibiki T, Nakamura T, Gatzoulis MA, Niwa K. Influence of early repair of tetralogy of Fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach. Cardiol Young 2002;12:345-351.

5. Atik FA, Atik E, Cunha CR, Caneo LF, Assad RS, Jatene MB, Riso A, Barbero-Marcial M. Long-term results of correction of tetralogy of Fallot in adulthood. Eur J Cardiovasc Surg 2004;25:250-255.

6. Murphy JG, Gersh BJ, Mair DD, Fuster V, McGoon MD, Ilstrup DM, McGoon DC, Kirklin JW, Danielson GK. Long-Term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993;329:593-599.

7. Joffe H, Georgakopoulos D, Celermajer DS, Sullivan ID, Deanfield JE. Late ventricular arrhythmia is rare early after repair of tetralogy of Fallot. J Am Coll Cardiol 1994;23:1146-1150.

8. Waien SA, Liu PP, Ross BL, Williams WG, Webb GD, McLaughlin PR. Serial follow-up of adults with repaired tetralogy of Fallot. J Am Coll Cardiol 1992;20:295-300.

9. Nollert G, Fischlein T, Bouterwek S, Bohmer C, Klinner W, Reichart B. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 1997;30:1374-1383.

10. Hansen DE, Craig CS, Hondeghem LM. Stretch-induced arrhythmias in the isolated canine ventricle. Evidence for the importance of mechanoelectrical feedback. Circulation 1990; 81: 1094-1105.

11. Misaki T, Tsubota M,Watanabe G, Watanabe Y, Matumoto Y, Ispida K, Iwa T, Okada R. Surgical treatment of ventricular tachycardia after surgical repair of tetralogy of Fallot. Relation between intraoperative mapping and histological findings. Circulation 1994;90:264-271.

12. Downar E, Harris L, Kimber S, Micklebourgh L, Williams W, Sevaptsidis E, Masse S, Chen TC, Chan A, Genga A. ventricular tachycardia after surgical repair of tetralogy of Fallot: results of intraoperative mapping studies. J Am Coll Cardiol 1992;20:648-655.

13. Deanfield J, McKenna W, Rowland E. Local abnormalities of right ventricular depolarization after repair of tetralogy of Fallot: a basis for ventricular arrhythmia. Am J Cardiol 1985; 55: 522-525.

14. Chandar JS, Wolff S, Garson A, et al. Ventricular arrhythmias in postoperative tetralogy of Fallot. Am J Cardiol 1990;65:655-661.

15. Friedli B, Bolens M, Taktak M. Conduction disturbances after correction of tetralogy of Fallot: are electrophysiologic studies of prognostic value? J Am Coll Cardiol 1988;11:162-165.

16. Roos-Hesselink J, perlroth MG, McGhie J, Spitaels S. Atrial arrhythmias in adults after repair of tetralogy of Fallot. Correlation with clinical, exercise, and echocardiographic findings. Circulation 1995:91:2214-2219.

17. Houyel L, Vaksmann G, Fournier A, Davignon A. Ventricular arrhythmias after correction of ventricular septal defects: importance of surgical approach. J Am Coll Cardiol 1990;16:1224-1228.

18. Deanfield JE, McKenna WJ, Hallidie-Smith KA. Detection of late arrhythmia and conduction disturbance after correction of tetralogy of Fallot. Br Heart J 1980;44:248-253.

19. Rosenthal A, Behrendt D, Sloan H, Ferguson P, Snedecor SM, Schork A. Long-term prognosis (15 to 26 years) after repair of tetralogy of Fallot: survaival and symptomatic status. Ann Thorac Surg 1984;38:151-156.

20. Hokanson JS, Moller JH. Significance of early transient complete heart block as a predictor of sudden death late after operative correction of tetralogy of fallot. Am J Cardiol 2001;87:1271–1277)

21. Nakazawa M, Shinohara T, Sasaki A, Echigo S, Kado H, Niwa K, Oyama K, Yokota M, Iwamoto M, Fukushima N, Nagashima M, Nakamura Y,; study group for arrhythmias long-term after surgery for congenital heart disease: ALTAS-CHD study. Arrhythmias late after repair of tetralogy of Fallot: a japanense multicenter study. Circ J 2004;68:126-130.

22. Harrison DA, Siu SC, Hussain F, MacLoghlin CJ, Webb GD, Harris L. Sustained atrial arrhythmias in adults late after repair of tetralogy of Fallot. Am J Cardiol 2001;87:584-588.

23. Nakagawa H, Shah N, Matsudaira K, Overholt E, Chandrasekaran K, Beckman KJ, Spector P, Calama JD, Rao A, Hasdemir C, Otomo K, Wang Z, Lazzara R, Jackman WM. Characterization of re-entrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease: isolated channels between scars allow “focal” ablation. Circulation 2001;103:699-709.

24. Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, Rosenthal M, Nakazawa M, Moller JH, Gillette PC, Webb GD, Redington AN. Risk factors for arrhythmia and sudden death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000;356:975-981.

25. Berul CI, Hill SL, Geggel RL, Hijazi ZM, Marx GR, Rhodes J, Walsh KA, Fulton DR. Electrocardiographic markers of late sudden death risk in postoperative tetralogy of Fallot children. J Cardiovasc Electrophysiol 1997;8:1349-1356.

26. Gatzoulis MA, Till JA, Somerville J, Redington AN. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predictes malignant ventricular arrhythmias and sudden death. Circulation 1995;92:158-159.

27. Daliento L, Rizzoli G, Menti L, Baratella MC, Turrin P, Nava A, Dalla Volta S. Accuracy of electrocardiographic and echocardiographic indices in predicting life threatening ventricular arrhythmias in patients operated for tetralogy of Fallot. Heart 1999;81:650-655.

28. BalaJi S, Lau YR, Case CL, Gillette PC. QRS prolongation is associated with inducible ventricular tachycardia after repair of tetralogy of Fallot. Am J Cardiol 1997;80:160-163.

29. Norgard G, Gatzoulis MA, Moraes F, et al. The relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot: implications for long-term outcome Circulation 1996; 94: 3276–3281.

30. Daliento L, Caneve F, Turrini P, Buja G, Nava A, Milanesi O, Stellin G, Rizzoli G. Clinical significance of high-frequency., low-amplitude electrocardiogrphic signals and QT dispersion in patients operated on for tetralogy of Fallot. Am J Cardiol 1995;76:408-411.

31. Giroud D, Zimmermann M, Adamec R, Hoberhansli I, Friedli B. Ventricular late potentials and spontaneous ventricular arrhythmias after surgical repair of tetralogy of Fallot: do they have a prognostic value? Br Heart J 1994;72:580-583.

32. Rovamo L, Makijarvi M, Pesonen E, Wallgren EI, Toivonen L. Late potentials on signal-averaged electrocardiograms in childre after right ventriculotomy. Pediatr cardiol 1995;16:114-119.

33. Zimmermann M, Friedli B, Adamec R, Oberhansli I. Ventricular late potentials and induced ventricular arrhythmias after surgical repair of tetralogy of Fallot. Am J Cardiol 1991;67:873-878.

34. S Brili, C Aggeli, K Gatzoulis, A Tzonou, C Hatzos, C Pitsavos, C Stefanadis, P Toutouzas. Echocardiographic and signal averaged ECG indices associated with non-sustained ventricular tachycardia after repair of tetralogy of Fallot. Heart 2001;85:57–60.

35. Harrison DA, Harris L, Siu SC, MacLoghlin CJ, Connely MS, Webb GD, Downar E, McLaughlin PR, Williams WG. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol 1997;30:1368-1373.

36. Cullen S, Celermajer DS, Franklin RC, Hallidie-smith KA, Deanfield JE. Prognostic significance of ventricular arrhythmia after repair of tetralogy of Fallot: a 12-year prospective study. J Am Coll Cardiol 1994;23:1151-1155.

37. Cheung MM, Weintraub RG, Cohen RJ, Karl TR, Wilkinson JL, Davis AM. T wave alternans threshohld late after repair of tetralogy of Fallot. J Cardiovasc Electrophysiol 2002;13:657-661.

38. Daliento L, Folino AF, Menti L, Zanco P, Barbatella MC, Dalla Volta S. Adrenergic nervous system activity in patients after surgical correction of tetralogy of Fallot. J Am Coll Cardiol 2001;38:2043-2047.

39. Davos CH, Davlouros PA, Wensel R, Francis D, Davies LC, Kilner PJ, Coats AJ, Piepoli M, Gatzoulis MA. Global impairment of cardiac autonomic nervous activity late after repair of tetralogy of Fallot. Circulation 2002;106:69-75.

40. Folino AF, Russo G, Bauce B, Mazzotti E, Daliento L. Autonomic profile and arrhythmic risk stratification after surgical repair of tetralogy of Fallot. Am Heart J 2004;148:985-989.

41. Lucron H, Marcon F, Bosser G, Lethor JP, Marie PY, Brembilla-Perrot B. Induction of sustained ventricula tachicardia after surgical repair of tetralogy of Fallot. Am J Cardiol 1999;83:1369-1373.

42. Alexander ME, Walsh EP, Saul JP, Epstein MR, Triedman JK. Value of programmed ventricular stimulation in patients with congenital heart disease. J Cardiovasc Electrophysiol 1999;10:1033-1044.

43. Khairy P, Landzberg MJ, Gatzoulis MA, Lucron H, Lambert J, Marcon F, Alexander ME, Walsh EP. Value of programmed ventricular stimulation after tetralogy of Fallot repair: a multicenter study. Circulation 2004;109:1994-2000.

44. Helbing WA, Niezen RA, Le Cessie S et al. Right ventricular diastolic function in children with pulmonary regurgitation after repair of tetralogy of Fallot: volumetric evaluation by magnetic resonance velocity mapping. J Am Coll Cardiol 1996;28:1827-1835.

45. Kim RJ, Chen EL, Lima JA, Judd MR. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after reperfused infarction. Circulation 1996;94:3318-3326.

46. Kim RJ, Fieno DS, Parrish TB et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age and contractile function. Circulation 1999;94:1992-2002.

47. Garson A, Randall JC, Gillette PC, Smith RT, Moak JP, McVey P, McNamara DG. Prevention of sudden death after repair of tetralogy of Fallot: treatment of ventricular arrhythmias. J Am Coll Cardiol 1985;6:221-227.

48. Dore A, Santagata P, Dubuc M, Mercier LA. Implantable cardioverter defibrillator in adults with congenital heart disease: a single center experience. Pacing Clin Electrophysiol 2004;27:47-51.

49. Therrien J, Siu SC, Harris L, et al. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 2001; 103: 2489-2494.

50. Biblo LA, Carlson MD. Transcatheter radiofrequency ablation of ventricular tachycardia following surgical correction of tetralogy of Fallot. Pacing Clin Electrophysiol 1994; 17:1556-1560.

51. Rostock T, Willems S, Ventura R, Weiss C, Risius T, Meinertz T. Radiofrequency catheter ablation of a macroreentrant ventricular tachycardia late after surgical repair of tetralogy of Fallot using the electroanatomic mapping (CARTO). Pacing Clin Electrophysiol 2004;27:801-804.


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