Ventricular arrhythmia risk stratification in patients with tetralogy of fallot at the time of pulmonary valve replacement

Anna Sabate Rotes, Heidi M. Connolly, Carole A. Warnes, Naser M. Ammash, Sabrina D. Phillips, Joseph A. Dearani, Hartzell V Schaff, Harold M. Burkhart, David O. Hodge, Samuel J Asirvatham, Christopher J. McLeod

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background - Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. Methods and Results - A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8%) and 37 (16%) had left ventricular dysfunction, defined as left ventricular ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95%, 90%, and 79%, respectively. In the first year after PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of ventricular tachycardia and left ventricular dysfunction was associated with higher risk for the combined event (hazard ratio, 4.7; P=0.004 and hazard ratio, 0.8; P=0.02, respectively). Conclusions - Patients with repaired tetralogy of Fallot undergoing PVR with history of ventricular tachycardia or left ventricular dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high-risk patients, surgical cryoablation does not seem to increase arrhythmic events and may be protective.

Original languageEnglish (US)
Pages (from-to)110-116
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number1
DOIs
StatePublished - Feb 28 2015

Fingerprint

Pulmonary Valve
Tetralogy of Fallot
Cardiac Arrhythmias
Ventricular Tachycardia
Cryosurgery
Left Ventricular Dysfunction
Out-of-Hospital Cardiac Arrest
Implantable Defibrillators
Sudden Cardiac Death
Stroke Volume

Keywords

  • arrhythmias, cardiac
  • cryosurgery
  • heart valve prosthesis implantation
  • pulmonary valve
  • tetralogy of Fallot

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Rotes, A. S., Connolly, H. M., Warnes, C. A., Ammash, N. M., Phillips, S. D., Dearani, J. A., ... McLeod, C. J. (2015). Ventricular arrhythmia risk stratification in patients with tetralogy of fallot at the time of pulmonary valve replacement. Circulation: Arrhythmia and Electrophysiology, 8(1), 110-116. https://doi.org/10.1161/CIRCEP.114.001975

Ventricular arrhythmia risk stratification in patients with tetralogy of fallot at the time of pulmonary valve replacement. / Rotes, Anna Sabate; Connolly, Heidi M.; Warnes, Carole A.; Ammash, Naser M.; Phillips, Sabrina D.; Dearani, Joseph A.; Schaff, Hartzell V; Burkhart, Harold M.; Hodge, David O.; Asirvatham, Samuel J; McLeod, Christopher J.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 8, No. 1, 28.02.2015, p. 110-116.

Research output: Contribution to journalArticle

Rotes, Anna Sabate ; Connolly, Heidi M. ; Warnes, Carole A. ; Ammash, Naser M. ; Phillips, Sabrina D. ; Dearani, Joseph A. ; Schaff, Hartzell V ; Burkhart, Harold M. ; Hodge, David O. ; Asirvatham, Samuel J ; McLeod, Christopher J. / Ventricular arrhythmia risk stratification in patients with tetralogy of fallot at the time of pulmonary valve replacement. In: Circulation: Arrhythmia and Electrophysiology. 2015 ; Vol. 8, No. 1. pp. 110-116.
@article{d3efb62ee88847098a2a2d270f3c0d0e,
title = "Ventricular arrhythmia risk stratification in patients with tetralogy of fallot at the time of pulmonary valve replacement",
abstract = "Background - Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. Methods and Results - A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8{\%}) and 37 (16{\%}) had left ventricular dysfunction, defined as left ventricular ejection fraction <50{\%}. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7{\%}). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95{\%}, 90{\%}, and 79{\%}, respectively. In the first year after PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of ventricular tachycardia and left ventricular dysfunction was associated with higher risk for the combined event (hazard ratio, 4.7; P=0.004 and hazard ratio, 0.8; P=0.02, respectively). Conclusions - Patients with repaired tetralogy of Fallot undergoing PVR with history of ventricular tachycardia or left ventricular dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high-risk patients, surgical cryoablation does not seem to increase arrhythmic events and may be protective.",
keywords = "arrhythmias, cardiac, cryosurgery, heart valve prosthesis implantation, pulmonary valve, tetralogy of Fallot",
author = "Rotes, {Anna Sabate} and Connolly, {Heidi M.} and Warnes, {Carole A.} and Ammash, {Naser M.} and Phillips, {Sabrina D.} and Dearani, {Joseph A.} and Schaff, {Hartzell V} and Burkhart, {Harold M.} and Hodge, {David O.} and Asirvatham, {Samuel J} and McLeod, {Christopher J.}",
year = "2015",
month = "2",
day = "28",
doi = "10.1161/CIRCEP.114.001975",
language = "English (US)",
volume = "8",
pages = "110--116",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Ventricular arrhythmia risk stratification in patients with tetralogy of fallot at the time of pulmonary valve replacement

AU - Rotes, Anna Sabate

AU - Connolly, Heidi M.

AU - Warnes, Carole A.

AU - Ammash, Naser M.

AU - Phillips, Sabrina D.

AU - Dearani, Joseph A.

AU - Schaff, Hartzell V

AU - Burkhart, Harold M.

AU - Hodge, David O.

AU - Asirvatham, Samuel J

AU - McLeod, Christopher J.

PY - 2015/2/28

Y1 - 2015/2/28

N2 - Background - Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. Methods and Results - A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8%) and 37 (16%) had left ventricular dysfunction, defined as left ventricular ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95%, 90%, and 79%, respectively. In the first year after PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of ventricular tachycardia and left ventricular dysfunction was associated with higher risk for the combined event (hazard ratio, 4.7; P=0.004 and hazard ratio, 0.8; P=0.02, respectively). Conclusions - Patients with repaired tetralogy of Fallot undergoing PVR with history of ventricular tachycardia or left ventricular dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high-risk patients, surgical cryoablation does not seem to increase arrhythmic events and may be protective.

AB - Background - Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR. Methods and Results - A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8%) and 37 (16%) had left ventricular dysfunction, defined as left ventricular ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95%, 90%, and 79%, respectively. In the first year after PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of ventricular tachycardia and left ventricular dysfunction was associated with higher risk for the combined event (hazard ratio, 4.7; P=0.004 and hazard ratio, 0.8; P=0.02, respectively). Conclusions - Patients with repaired tetralogy of Fallot undergoing PVR with history of ventricular tachycardia or left ventricular dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high-risk patients, surgical cryoablation does not seem to increase arrhythmic events and may be protective.

KW - arrhythmias, cardiac

KW - cryosurgery

KW - heart valve prosthesis implantation

KW - pulmonary valve

KW - tetralogy of Fallot

UR - http://www.scopus.com/inward/record.url?scp=84923922948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923922948&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.114.001975

DO - 10.1161/CIRCEP.114.001975

M3 - Article

C2 - 25416756

AN - SCOPUS:84923922948

VL - 8

SP - 110

EP - 116

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 1

ER -