(Circulation. 2001;103:2489.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Pulmonary Valve Replacement on Arrhythmia Propensity Late After Repair of Tetralogy of Fallot
From the University of Toronto Congenital Cardiac Center for Adults, Toronto, Ontario, Canada (J.T., S.C.S., L.H., W.G.W., G.W., M.A.G.); the Montreal Heart Institute, Montreal, Quebec, Canada (A.D.); the Chiba Cardiovascular Center, Chiba, Japan (K.N.); and the Kardiocentrum, University Hospital Motol, Prague, Czech Republic (J.J.). Dr Gatzoulis is currently affiliated with the Adult Congenital Heart Program, Royal Brompton Hospital, London, UK.
Correspondence to Judith Therrien, Sir MB Davis Jewish General Hospital, 3755 Cote Ste Catherine, Montreal, Quebec, H3T 1E2 Canada. E-mail judiththerrien{at}hotmail.com
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<0.001) in a comparable group of patients with repaired TOF who did not undergo PVR. At a mean follow-up of 4.7 years, the incidence of ventricular tachycardia diminished from 22% to 9% (P<0.001), and atrial flutter/fibrillation decreased from 17% to 12% (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.
Key Words: pulmonary valve • ablation • tetralogy of Fallot • heart diseases
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