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Impact of Pulmonary Valve Replacement on Arrhythmia Propensity Late After Repair of Tetralogy of Fallot

Authors :
Louise Harris
Judith Therrien
Samuel Siu
Annie Dore
Koichiro Niwa
William G. Williams
J. Janousek
Gary Webb
Michael A. Gatzoulis
Source :
Circulation. 103:2489-2494
Publication Year :
2001
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2001.

Abstract

Background —Chronic pulmonary regurgitation after repair of tetralogy of Fallot (TOF) may lead to right ventricular dilatation, which may be accompanied by ventricular tachycardia and sudden death. We aimed to examine the effects of pulmonary valve replacement (PVR) on (1) certain electrocardiographic markers predictive of monomorphic ventricular arrhythmia and sudden death and (2) sustained atrial flutter/fibrillation and monomorphic ventricular tachycardia. Methods and Results —We studied 70 patients who underwent PVR for pulmonary regurgitation and/or right ventricular outflow tract obstruction late after repair of TOF. Maximum QRS duration and QT dispersion were measured from standard ECGs before PVR and at the latest follow-up. Arrhythmia was defined as sustained atrial flutter/fibrillation or sustained monomorphic ventricular tachycardia. Concomitant intraoperative electrophysiological mapping and/or cryoablation were performed in 9 patients (60%) with preexisting ventricular tachycardia and 6 patients (50%) with preexisting atrial flutter. QRS duration remained unchanged in the study group ( P =0.46), but it was significantly prolonged ( P P P =0.32). Intraoperative ablation prevented recurrence of preexisting tachyarrhythmia (0 of 15 patients). Conclusions —PVR in patients with previous TOF repair and chronic pulmonary regurgitation leads to stabilization of QRS duration and, in conjunction with intraoperative cryoablation, to a decrease in the incidence of preexisting atrial and ventricular tachyarrhythmia. When applicable, this combined approach should be used in patients late after repair of TOF.

Details

ISSN :
15244539 and 00097322
Volume :
103
Database :
OpenAIRE
Journal :
Circulation
Accession number :
edsair.doi.dedup.....0ea24d582d355302546df10a322d8914
Full Text :
https://doi.org/10.1161/01.cir.103.20.2489