scholarly journals Differences in ventricular tachycardia inducibility in patients with Tetralogy of Fallot depending on the clinical indication for the electrophysiologic study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Herrador Galindo ◽  
J Francisco Pascual ◽  
A Santos Ortega ◽  
J Perez Rodon ◽  
B Benito ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Clinical Indication ◽  
Study Group ◽  
Electrophysiologic Study ◽  
Clinical Scenarios ◽  
Significant Difference

Abstract Introduction The arrhythmic risk stratification of patients with repaired Tetralogy of Fallot (TOF) is still controversial. The performance of an electrophysiologic (EP) study before pulmonary valve replacement (PVR), regardless of patient's risk factors, is an extended practice in some centers that is not recommended in current guidelines. The aim of our study was to explore the differences in ventricular tachycardia (VT) inducibility in patients with TOF during programmed ventricular stimulation (PVS) depending on the clinical indication. Methods All patients with repaired TOF who underwent an EP study with PVS between January 2001 and October 2020 were included. EP studies performed in the context of ventricular or supraventricular tachycardia ablations that had been previously diagnosed were excluded. We defined two clinical scenarios for performing the EP study: pre-PVR (performed previous to pulmonary valve replacement) or diagnostic EP study (performed due to high risk symptoms which included palpitations, syncope or presyncope). Baseline clinical information, electrocardiogram, echocardiogram and cardiac MRI parameters were retrospective recorded. Results A total of 139 EP studies with PVS were included; 87 in the pre-PVR group and 52 in the diagnostic EP study group. There was a greater incidence of palpitations, syncope and presyncope in the “Diagnostic EP study” group. Moreover, there were statistical significant differences in right ventricle dimensions and function between groups. The repair surgical approach was similar in both groups. It was detected a statistical significant difference in VT induction between the pre-PVR group and the diagnostic indicated group (16,1% vs 34,6%, p=0,012). Conclusions Differences in VT induction are observed during PVS performing in TOF patients depending on the clinical indication. Symptomatology is an important parameter that must be taken into account in order to decide whether to perform an EP study in this population. FUNDunding Acknowledgement Type of funding sources: None.

Pulmonary Allograft Versus Medtronic Freestyle Valve in Surgical Pulmonary Valve Replacement for Adults Following Correction of Tetralogy of Fallot or Its Variants

2019 ◽  
Vol 10 (5) ◽  
pp. 543-551 ◽  
Author(s):  
Pasangi Madhuka Wijayarathne ◽  
Peter Skillington ◽  
Samuel Menahem ◽  
Amalan Thuraisingam ◽  
Marco Larobina ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Surgical Repair ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Valve Replacement ◽  
Long Term Outcomes ◽  
Significant Difference

Background: Following corrective surgery in infancy/childhood for tetralogy of Fallot (TOF) or its variants, patients may eventually require pulmonary valve replacement (PVR). Debate remains over which valve is best. We compared outcomes of the Medtronic Freestyle valve with that of the pulmonary allograft valve following PVR. Methods: A retrospective study was undertaken from a single surgical practice of adult patients undergoing elective PVR between April 1993 and March 2017. The choice of valve was at the surgeon’s discretion. There was a trend toward the almost exclusive use of the more readily available Medtronic Freestyle valve since 2008. Results: One hundred fifty consecutive patients undergoing 152 elective PVRs were reviewed. Their mean age was 33.8 years. Ninety-four patients had a Medtronic Freestyle valve, while 58 had a pulmonary allograft valve. There were no operative or 30-day mortality. The freedom from reintervention at 5 and 10 years was 98% and 98% for the pulmonary allograft and 99% and 89% for the Medtronic Freestyle. There was no significant difference in the rate of reintervention, though this was colored by higher pulmonary gradients across the Medtronic Freestyle despite its shorter follow-up. Conclusions: Pulmonary valve replacement following previous surgical repair of TOF or its variants was found to be safe with no significant differences in mortality or reintervention between either valve. Although the Medtronic Freestyle valve had a greater tendency toward pulmonary stenosis, additional follow-up is needed to further document its long-term outcomes.

Abstract 3127: Pulmonary Valve Replacement in Tetralogy of Fallot: Impact on Survival and Freedom from Ventricular Tachycardia

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
David M Harrild ◽  
Tal Geva ◽  
Frank Pigula ◽  
Frank Cecchin ◽  
Charles I Berul ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Total Duration ◽  
Pulmonary Regurgitation ◽  
Case Control ◽  
Pulmonary Valve Replacement ◽  
Late Complications ◽  
Qrs Duration

Background : Pulmonary regurgitation (PR) in repaired tetralogy of Fallot (TOF) is associated with right ventricular (RV) dilation and dysfunction as well as arrhythmia. Pulmonary valve replacement (PVR) may prevent the development of these late complications. This retrospective study tests the hypothesis that PVR improves survival and freedom from ventricular tachycardia (VT) in patients with TOF. Methods : Enrolled patients had TOF with PVR for RV dilation from PR. Referral for PVR was largely based on symptoms. Controls (TOF patients with RV dilation but no PVR ), were matched by age (± 2 years) and QRS duration (± 30 msec). There were 77 case/control pairs. Pairs did not differ significantly for age, repair type, decade of TOF repair, age at TOF repair, or presence of pre-PVR VT. Primary outcome events were death and VT. Events were recorded only if they occurred while both case/control were actively followed. Total duration of post-PVR follow-up was 172 patient years per group (median 1.4y, 0.01 – 13.2). PVRs were performed between 1990 and 2005 at median age 21y (6 –57). Results: The change in QRS duration did not differ significantly between the two groups (p = 0.43). Other results are summarized in the table and figure below. Conclusion: In this cohort of patients with repaired TOF, late PVR for symptomatic PR/RV dilation did not lead to reduced incidence of VT and/or death.

Abstract 16466: Greater Body Mass Index Predicts Valve Function Following Transcatheter Pulmonary Valve Replacement in Adults With Tetralogy of Fallot

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zachary Daniels ◽  
Anudeep Dodeja ◽  
Victoria Shay ◽  
Yubo Tan ◽  
Shasha Bai ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Body Mass ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Significant Difference ◽  
Valve Function ◽  
The Impact

Introduction: After the initial surgical repair of tetralogy of Fallot (rTOF), right ventricular outflow tract dysfunction is common, with pulmonary stenosis (PS), regurgitation, or both. Obese adults with rTOF have worse biventricular systolic function, and greater post-operative pulmonary valve replacement morbidity than non-obese patients. Transcatheter PVR (TPVR) is used increasingly, though no studies have examined the impact of body mass index (BMI) on morbidity and hemodynamics in adults with rTOF and subsequent TPVR. Hypothesis: BMI affects outcomes of transcatheter PVR in adults with TOF. Methods: This was a 10 yr, single center, retrospective review of adults (>18 yo) with rTOF who underwent TPVR. The cohort was split into 2 groups based on BMI at time of TPVR. Group A (Grp A): normal and overweight (BMI <30), group B (Grp B): obese (BMI ≥30). Pre and post-TPVR echocardiogram, cardiac MRI, and catheterization data were reviewed. Results: There were 81 adults, 42 (52%) normal, 18 (22%) overweight (Grp A) and 21 (26%) obese (Grp B). Mean follow up was 6.4 + 3.1 yrs. With most recent post-TPVR echocardiogram, there was no significant difference in LV or RV size and function across groups. Compared to Grp A, Grp B patients were more likely to develop any degree of PS (mild, moderate, or severe) following TPVR (69% vs 94%, respectively, p = 0.032). An ROC curve analysis demonstrated BMI ≥ 26.3 had a low sensitivity (45%), but good specificity (89%) for predicting PS post TPVR. There was no difference between groups requiring re- intervention for PVR. Conclusion: This is the first study to show greater BMI affects valve function in adults with rTOF following TPVR. BMI >26 was associated with a greater risk of PS in follow up echocardiograms after TPVR. Obesity is an epidemic in the US and patient prosthesis mismatch may be an issue when considering TPVR. Further studies are indicated to determine the long-term effects of BMI on TPVR and the need for re-intervention in adults with TOF.

Sign in / Sign up

Export Citation Format

Share Document