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(Circulation. 2007;116:2236-2237.)
© 2007 American Heart Association, Inc.

Editorial

Substrate Mapping and Catheter Ablation of Ventricular Tachycardia after Right Ventriculotomy

George F. Van Hare, MD

From the Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, Calif.

Correspondence to George F. Van Hare, MD, Pediatric Cardiology, 750 Welch Rd, Suite 305, Palo Alto, CA 94304. E-mail vanhare@stanford.edu

Key Words: Editorials • ablation • tachycardia • tetralogy of Fallot

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Tetralogy of Fallot is one of the most common forms of cyanotic congenital heart disease, estimated to occur in 0.26 per 1000 live births.¹ Long-term survival depends on definitive surgery; happily, survival after complete repair can now be expected in 98% of cases. Initial surgery may be palliative with the placement of a shunt, but complete repair is now offered in infancy with the expectation of survival well into adulthood. Although tetralogy patients occasionally require permanent pacemakers for atrioventricular block, and many will need to undergo periodic pulmonic valve and conduit replacement, by far the most worrisome problem such patients face is the prospect of sudden death. In the early days of corrective surgery, when this catastrophic outcome was first observed, it was initially hypothesized that atrioventricular block might be responsible.² Subsequently, attention shifted to the problem of malignant ventricular arrhythmias.³ It is now widely accepted that ventricular tachycardia in such patients is the likely cause of sudden death and is likely to be macroreentrant in nature.

Article p 2241

Although clear risk factors within the tetralogy population have been identified, sadly attempts using antiarrhythmic agents to prevent sudden death in tetralogy of Fallot patients have been disappointing,⁴ and high-risk patients are increasingly being referred for implantation of implantable cardioverter-defibrillators. Whereas this approach seems reasonable and may indeed be lifesaving, patients may well experience inappropriate defibrillator shocks, and one would like to be able to offer definitive therapy such as ablation of the tachycardia circuit. Groundbreaking work in the area . . . [Full Text of this Article]