Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-23T02:33:53.677Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of arrhythmias in patients with a tetralogy of Fallot

Published online by Cambridge University Press:  09 January 2014

Jamie A. Decker  and
Jeffrey J. Kim
Jamie A. Decker*
Affiliation:
Division of Pediatric Cardiology, All Children's Heart Institute, Saint Petersburg, Florida, United States of America
Jeffrey J. Kim
Affiliation:
Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, United States of America
*
Correspondence to: J. A. Decker, MD, Division of Pediatric Cardiology, All Children's Heart Institute, 601 5th Street South, Saint Petersburg, Florida, United States of America. Tel: +1 727 767 3333; Fax: +1 727 767 8900; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Although arrhythmias are commonly found in patients with all different types of congenital heart disease, perhaps no patient is at higher risk of late development of arrhythmias that may result in sudden death than in the patient following tetralogy of Fallot repair. Despite major improvement in the surgical repair of this disease, a significant percentage of these patients continue to remain at risk for the late development of arrhythmias, and a small percentage will develop life-threatening arrhythmias and sudden death. Which patients remain at highest risk is still not clearly delineated. Diligent arrhythmia surveillance and aggressive treatment strategies are necessary to minimise this risk. This article highlights important strategies to manage arrhythmia development and prevention in this patient population.

Keywords

Tetralogy of fallotsudden cardiac deatharrhythmiascongenital heart diseaseVT
Type
Original Article
Information
Cardiology in the Young , Volume 23 , Issue 6: HeartWeek 2013 , December 2013 , pp. 888 - 895
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Lillehei, CW, Cohen, M, Warden, HE, et al. Direct vision intracardiac surgical correction of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary atresia defects; reports of first ten cases. Ann Surg 1955; 142: 418–442.Google Scholar
2.Abd El Rahman, MY, Abdul-Khaliq, H, Vogel, M, et al. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart 2000; 84: 416–420.Google Scholar
3.Gatzoulis, MA, Till, JA, Somerville, J, Redington, AN. Mechanoelectrical interaction in tetralogy of Fallot: QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation 1995; 92: 231–237.Google Scholar
4.Ghai, A, Silversides, C, Harris, L, Webb, GD, Siu, SC, Therrien, J. Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol 2002; 40: 1675–1680.Google Scholar
5.Van Arsdell, GS, Maharaj, GS, Tom, J, et al. What is the optimal age for repair of tetralogy of Fallot? Circulation 2000; 102 (Suppl 3): III123–III129.Google Scholar
6.Hirsch, JC, Mosca, RS, Bove, EL. Complete repair of tetralogy of Fallot in the neonate: results in the modern era. Ann Surg 2000; 232: 508–514.Google Scholar
7.Morales, DL, Zafar, F, Fraser, CD. Tetralogy of Fallot: the right ventricular infundibulum sparing (RVIS) strategy. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009; 12: 54–58.Google Scholar
8.Kanter, KR, Kogon, BE, Kishbom, PM, et al. Symptomatic neonatal tetralogy of Fallot: repair or shunt? Ann Thorac Surg 2010; 89: 858–863.Google Scholar
9.Hoffman, TM, Bush, DM, Wernovsly, G, et al. Postoperative junctional ectopic tachycardia: incidence, risk factors, and treatment. Ann Thorac Surg 2002; 74: 1607–1611.Google Scholar
10.Madapati, R, Byrum, CJ, Kavey, RE, et al. Procainamide for rate control of postsurgical junctional tachycardia. Pediatr Cardiol 2000; 21: 123–128.Google Scholar
11.Chrysstomou, C, Beerman, L, Shiderly, D, et al. Dexmedetomidine: a novel drug for the treatment of atrial and junctional tachyarrhythmias during the perioperative period for congenital cardiac surgery: a preliminary study. Anesth Analg 2008; 107: 1514–1522.Google Scholar
12.Epstein, AE, DiMarco, JP, Ellenbogen, KA, et al. ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force of Practice Guidelines. J Am Coll Cardiol 2008; 51: e1–e62.CrossRefGoogle Scholar
13.Quattlebaum, TG, Varghese, J, Neill, CA, et al. Sudden death among post-operative patients with tetralogy of Fallot: a follow-up study of 243 patients for an average of twelve years. Circulation 1976; 54: 289–293.Google Scholar
14.Khairy, P, Aboulhoson, J, Gurvitz, MZ, et al. Arrhythmia burden in adults with surgically repaired tetralogy of Fallot. Circulation 2010; 122: 868–875.Google Scholar
15.Gatzoulis, MA, Balaji, S, Webber, SA, et al. Risk factors for arrhythmias and sudden cardiac death later after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975–981.Google Scholar
16.Khairy, P, Dore, A, Talajic, M, et al. Arrhythmias in adult congenital heart disease. Expert Rev Cardiovasc Ther 2006; 4: 83–95.Google Scholar
17.Silka, MJ, Hardy, BG, Menashe, VD, Morris, CD. A population-based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol 1998; 32: 245–251.Google Scholar
18.Dietl, CA, Cazzanigna, ME, Dubner, SJ, Perez-Balino, NA, Torres, AR, Favaloro, RG. Life-threatening arrhythmias and RV dysfunction after surgical repair of tetralogy of Fallot. Comparison between transventricular and transatrial approaches. Circulation 1994; 90: II7–II12.Google Scholar
19.Nui, MC, Morris, SA, Morales, DL, et al. Low incidence of arrhythmias in the right ventricular infundibulum sparing approach to tetralogy of Fallot. Pediatr Cardiol 2013, Epub.Google Scholar
20.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.Google Scholar
21.Knauth, AL, Gauvreau, K, Powell, AJ, et al. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 2008; 94: 211–216.CrossRefGoogle ScholarPubMed
22.Babu-Narayan, SV, Kilner, PJ, Li, W, et al. Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of Fallot and its relationship to adverse markers of clinical outcomes. Circulation 2006; 113: 405–413.Google Scholar
23.Aboulhoson, JA, Lluri, G, Gurvitz, MZ, et al. Left and right ventricular diastolic function in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Can J Cardiol 2013; 29: 866–872.Google Scholar
24.Vogel, M, Sponring, J, Cullen, S, et al. Regional wall motion and abnormalities of electrical depolarization and repolarization in patients after surgical repair of tetralogy of Fallot. Circulation 2001; 103: 1669–1673.Google Scholar
25.Helbing, WA, Roest, AW, Niezen, RA, et al. ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation. Heart 2002; 88: 515–520.Google Scholar
26.Russo, G, Folino, AF, Mazzotti, E, et al. Comparison between QRS duration at standard ECG and signal-averaging ECG for arrhythmic risk stratification after surgical repair of tetralogy of Fallot. J Cardiovasc Electrophys 2005; 16: 288–292.Google Scholar
27.Chiu, SN, Chiu, HH, Wang, JK, et al. Increased microvolt T-wave alternans in patients with repaired tetralogy of Fallot. Int J Card 2012; 159: 220–224.Google Scholar
28.Berul, CI, Hill, SL, Geggel, RL, et al. Electrocardiographic markers of late sudden death risk in postoperative tetralogy of Fallot children. J Card Electrophys 1997; 8: 1349–1356.Google Scholar
29.Czosek, RJ, Anderson, J, Khoury, PR, et al. Utility of ambulatory monitoring in patients with congenital heart disease. Am J Cardiol 2013; 111: 723–730.CrossRefGoogle ScholarPubMed
30.Rodriguez, FH, Moodie, DS, Neeland, M, et al. Identifying arrhythmias in adults with congenital heart disease by 24-h ambulatory electrocardiography. Pediatr Cardiol 2012; 33: 591–595.Google Scholar
31.Cullen, S, Celermajer, DS, Franklin, RC, et al. Prognostic significance of ventricular arrhythmia after repair of tetralogy of Fallot: a 12-year prospective study. J Am Coll Cardiol 1992; 20: 295–300.Google Scholar
32.Garson, A Jr, Nihill, MR, McNamara, DG, et al. Status of the adult and adolescent after repair of tetralogy of Fallot. Circulation 1979; 59: 1232–1240.Google Scholar
33.Harrison, DA, Harris, L, Siu, SC, et al. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol 1997; 30: 1368–1373.CrossRefGoogle ScholarPubMed
34.Roos-Hesselink, J, Perlroth, M, McGhie, J, et al. Atrial arrhythmias in adults after repair of tetralogy of Fallot. Correlations with clinical, exercise and echocardiographic findings. Circulation 1995; 91: 2214–2219.Google Scholar
35.Wessel, H, Paul, M. Exercise studies in tetralogy of Fallot: a review. Ped Cardiol 1999; 20: 39–47.Google Scholar
36.Garson, A, Gillette, P, Gutgesell, H, et al. Stress-induced ventricular arrhythmia after repair of tetralogy of Fallot. Am J Cardiol 1980; 46: 1006–1012.Google Scholar
37.Khairy, P, Landzberg, MJ, Gatzoulis, MA, et al. Value of programmed ventricular stimulation after tetralogy of Fallot repair: a multicenter study. Circulation 2004; 109: 1994–2000.Google Scholar
38.De Groot, NM, Lukac, P, Schalij, MJ, et al. Long-term outcome of ablative therapy of post-operative atrial tachyarrhythmias in patients with tetralogy of Fallot: a European multi-centre study. Europace 2012; 14: 522–527.Google Scholar
39.Zeppenfeld, K, Schalij, MJ, Bartelings, MM, et al. Catheter ablation of ventricular tachycardia after repair of congenital heart disease: electroanatomic identification of the critical right ventricular isthmus. Circulation 2007; 116: 2241–2252.Google Scholar
40.Therrien, J, Provost, Y, Mechant, N, et al. Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair. Am J Cardiol 2005; 95: 779–782.Google Scholar
41.Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee on the management of adults with congenital heart disease). J Am Coll Cardiol 2008; 52: E143–E263.Google Scholar
42.Silversides, CK, Kiess, M, Beauchesne, L, et al. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: outflow tract obstruction, coarctation of the aorta, tetralogy of Fallot, Ebstein anomaly and Marfan's syndrome. Can J Cardiol 2010; 26: e80–e97.Google Scholar
43.Baumgartner, H, Bonhoeffer, P, De Groot, NM, et al. Task Force on the management of grown-up congenital heart disease of the European Society of Cardiology (ESC); Association for European Paediatric Cardiology (AEPC). Eur Heart J 2010; 31: 2915–2957.Google Scholar
44.Harrild, DM, Berul, CI, Cecchin, F, et al. Pulmonary valve replacement in tetralogy of Fallot: impact on survival and ventricular tachycardia. Circulation 2009; 119: 445–451.Google Scholar
45.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.Google Scholar
46.Khairy, P, Harris, L, Landzberg, MJ, et al. Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation 2008; 117: 363–370.Google Scholar
47.Berul, CI, Van Hare, GF, Kertesz, NJ, et al. Results of a multicenter retrospective implantable cardioverter-defibrillator registry of pediatric and congenital heart disease patients. J Am Coll Cardiol 2008; 29: 1685–1691.Google Scholar
48.Yap, SC, Roos-Hesselink, JW, Hoendermis, ES, et al. Outcome of implantable cardioverter defibrillators in adults with congenital heart disease: a multi-centre study. Eur Heart J 2007; 28: 1854–1861.Google Scholar
49.Koyak, Z, de Groot, JR, Bouma, BJ, et al. Symptomatic but not asymptomatic non-sustained ventricular tachycardia is associated with appropriate implantable cardioverter therapy in tetralogy of Fallot. Int J Cardiol 2012; 167: 1532–1535.CrossRefGoogle Scholar