Abstract 10663: Clinical Arrhythmia Risk Stratification in the Young Adult With Repaired Tetralogy of Fallot in the Current Era
Background: Young adult patients (pts) with repaired Tetralogy of Fallot (RTOF) remain at risk for arrhythmias (Ar) and sudden cardiac death (SCD). Based on past studies with earlier pt subsets, Ar/SCD were associated with right ventricular (RV) systolic pressures (RVSP) >60mmHg, outflow tract (RVOT) gradients >20mmHg and QRS duration >180ms. However, there are limited recent studies of current RTOF pts equating Ar/SCD with clinical symptoms, echocardiographc (ECHO), electrophysiologic (EP), hemodynamic and RV volume (CMRI) findings. The purpose of this study was to evaluate Ar/SCD risk factors in the current generation of RTOF pts.
Methods: Pts seen in the Adult Congenital Heart program with RTOF (mean followup 25 y) were divided into 2 groups: Group 1: +Ar/SCD; Group 2 -Ar/SCD. Ar/SCD were correlated with current pt age, gender, age at repair, and repair types (transannular patch (I); no patch (II); conduit (III); shunt only (IV)), ECHO, CMRI, ECG/Holter, hemodynamic and EP results.
Results: Of a total of 136 pts (66 male / 70 female) ages 11-58y (mean 26), 82 (60%) had Ar (Group 1) (21% atrial, 53% ventricular, 15% both) and 3 (5%) had a SCD episode. These pts were older with repair at an older age than those without Ar/SCD (Group 2). QRS duration (78-240, mean 158ms) and RVSP (23-116, mean 44mmHg) were persistent risk factors. However, there was no correlation with type of surgical repair, gender, RV pressure >60mmHg, RVOT gradient >20mmHg, or RV endiastolic volume on CMRI (Table). EP cath induced a clinical Ar in 91% of Group 1 pts studied, leading to ablation or device implant.
Conclusions: Ar/SCD correlate with age at initial repair and advancing pt age. QRS duration and RVSP remain risk factors but at a shorter interval (158ms) and less RV pressure (44mmHg) than previously reported. In the current RTOF pt subset, neither type of repair, RV outflow gradient, nor RV volume correlate with Ar/SCD. EP studies remain a useful diagnostic tool to delinate mechanisms for Ar and risk for SCD.
- Tetralogy of Fallot
- Adult congenital heart disease
- Congenital heart disease
- Magnetic resonance imaging
- Sudden cardiac death
- © 2012 by American Heart Association, Inc.