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(Circulation. 1995;91:2118-2119.)
© 1995 American Heart Association, Inc.

Articles

Atrial Arrhythmias in Adults After Repair of Tetralogy of Fallot

Joseph K. Perloff, MD; Paul D. Natterson, MD

From the Departments of Medicine and Pediatrics, Divisions of Medical and Pediatric Cardiology, and the UCLA Adult Congenital Heart Disease Center, Los Angeles, Calif.

Correspondence to Joseph K. Perloff, MD, UCLA Adult Congenital Heart Disease Center, UCLA School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90021-1678.

	Introduction

 
Because sudden death has been an important concern in patients who have undergone intracardiac repair of Fallot's tetralogy, electrophysiological interest has understandably focused on high-degree heart block and ventricular arrhythmias. High-degree heart block has yielded to ventricular tachycardia as the probable cause of sudden death. By reason of the attention devoted to ventricular electrical instability, comparatively little attention has been paid to disturbances in atrial rhythm. The timely study from the Adult Congenital Heart Disease Clinic of the Thorax Center, Rotterdam, addressed this important deficiency and put into perspective the incidence and significance of atrial arrhythmias in adults after repair of Fallot's tetralogy. The relatively early era of cardiac surgery reflected in the report was a necessity, not a shortcoming, because the data were derived from an adult patient population after a mean follow-up of 17.5 years (1.4 to 32 years). The observations are therefore based on a wide variety of surgical techniques, a relatively broad age range at time of operation, and a substantial follow-up. Significantly, the surgical and follow-up data were derived entirely from patients at a single center.

The authors "carefully sifted through all available material in search of rhythm disturbances as they appeared on monitor strips, routine ECG tracings, and Holter records." Access to multiple Holter monitor tracings increased the probability of arrhythmia detection. Perioperative atrial arrhythmias as well as those occurring during cardiac catheterization were appropriately excluded. The diligence with which atrial arrhythmias were sought goes a long way in explaining their relatively high incidence. . . . [Full Text of this Article]

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