Ventricular tachycardia and sudden cardiac death might complicate the long-term outcome by patients after tetralogy of Fallot repair

2008 ◽  
Vol 149 (23) ◽  
pp. 1067-1069
Author(s):  
Attila Mihálcz ◽  
Csaba Földesi ◽  
Tamás Szili-Török
Keyword(s):  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Tetralogy Of Fallot ◽  
Cardiac Death ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cardioverter Defibrillator ◽  
Tetralogy Of Fallot Repair

A Fallot-tetralógia miatti műtétet követően a hosszú távú túlélést befolyásoló tényezők közé tartozik a kamrai tachycardia és a hirtelen szívhalál. E betegek gondozásában érdemi segítséget jelent az implantálható cardioverter defibrillátor rendszer. A végleges pacemaker és/vagy implantálható cardioverter defibrillátor implantációját követően ritka, ám potenciálisan letális kimenetelű fertőzéses szövődmény az endocarditis. Ez esetben a leghatékonyabb kezelési mód a kombinált terápia, amely a beültetett készülék + elektródák teljes körű eltávolításából és agresszív antibiotikus kezelésből áll. Célkitűzés: Ilyen esetekben a tervezett reimplantáció különös óvatosságot igényel a nagyobb recidívaarány miatt, amelynek rizikója fokozottabb pacemakerdependencia esetén. Célunk olyan módszer alkalmazása volt, amelynek segítségével a recidíva kockázata minimálisra csökkenthető. Módszer: Esetünkben a korábban Fallot-tetralógia miatt többször műtött, pacemaker-, majd implantálható cardioverter defibrillátor beültetéseken átesett betegnél recidív endocarditis miatt készülék- és elektródaeltávolítást végeztünk, standard antibiotikus terápia alkalmazásával. A reimplantációt minithoracotomián keresztül végeztük. Az így elhelyezett sokkelektróda elégtelen működése miatt egy másik sokkelektródát szubkután vezettünk a hátsó mellkasfali régióba; rendszerünk az indukált kamrafibrillációt sikerrel szüntette meg. Megbeszélés: Esetismertetésünk demonstrálja a szubkután defibrillátorrendszer alkalmazhatóságát és előnyeit speciális körülmények fennállásakor. Felhívjuk a figyelmet arra a tényre, hogy ezt a technikát gyakrabban is lehetne alkalmazni olyan esetekben, amelyekben a transzvénás implantáció nem optimális.

Prevention of sudden cardiac death in patients with Tetralogy of Fallot: Risk assessment and long term outcome

2018 ◽  
Vol 269 ◽  
pp. 91-96 ◽  
Author(s):  
Julia Probst ◽  
Gerhard-Paul Diller ◽  
Holger Reinecke ◽  
Patrick Leitz ◽  
Gerrit Frommeyer ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Sudden Cardiac Death ◽  
Tetralogy Of Fallot ◽  
Cardiac Death ◽  
Term Outcome ◽  
Long Term Outcome

5204Primary prevention of sudden cardiac death in patients with tetralogy of Fallot with implantable cardioverter defibrillator: insights from the DAI-T4F study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Waldmann ◽  
A Bouzeman ◽  
F Bessiere ◽  
F Labombarda ◽  
M Ladouceur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Tetralogy Of Fallot ◽  
Cardiac Death ◽  
Cardioverter Defibrillator ◽  
Programmed Ventricular Stimulation ◽  
Ventricular Stimulation

Abstract Background Ventricular arrhythmias and sudden death are feared late complications in patients with tetralogy of Fallot. Selection of candidates for primary prevention implantable cardioverter defibrillator (ICD) remains challenging in this population. Non-sustained ventricular tachycardia (NSVT), altered left ventricular ejection fraction (LVEF), positive programmed ventricular stimulation, and enlarged QRS are currently used for risk stratification. Purpose To identify high-risk patients with tetralogy of Fallot in the setting of primary prevention of sudden cardiac death. Methods The DAI-T4F study is a large ongoing national French registry including all patients with tetralogy of Fallot and ICD (NCT03837574). Information have been collected prospectively since 2010 with annual update. Baseline patient characteristics and clinical events during the follow-up were analyzed with central adjudication. Cox proportional hazard models were used to identify factors associated with appropriate ICD therapies. Results Among 134 patients enrolled, 47 (35.1%) underwent ICD implantation for primary prevention (median age 49.1 years, 76.6% males). At baseline, 20 (42.6%) patients had NSVT, 17 (36.2%) had severe altered LVEF ≤35%, 16 (34.0%) had positive programmed ventricular stimulation, and 16 (34.0%) had QRS duration ≥180ms. Overall, 20 (42.6%), 15 (31.9%), and 6 (12.8%) patients had respectively one, two, or ≥ three of these risk factors. Six (12.8%) patients were implanted for other indications. During a median (IQR) follow-up duration of 5.3 (2.1–8.0) years, 14 (29.8%) patients had at least one appropriate ICD therapy. The annual incidence of appropriate ICD therapies were 2.8%, 4.6%, 6.3%, and 8.6% in patients with none, one, two, or ≥ three of these factors (p for trend = 0.145). None of predictors, considered isolated, was significantly associated with ICD appropriate therapies. Patients with non-sustained ventricular tachycardia (NSVT) and positive programmed ventricular stimulation had a significant increased risk of ICD appropriate therapies (HR=3.8, 95% CI: 1.1–14.3, p=0.035), as well as patients with NSVT and QRSd ≥180 ms (HR=7.2, 95% CI: 1.6–32.7, p=0.003). No patient with severe altered LVEF without other risk factor had appropriate ICD therapy. Patients with congestive heart failure and/or altered LVEF had a higher risk of non-sudden death or cardiac transplantation (HR=14.4, 95% CI: 1.8–112.7, p<0.001). Seventeen (36.2%) patients experienced at least one ICD-related complication. Conclusions Our data illustrate that specific risk stratification and primary prevention for sudden cardiac death in patients with tetralogy of Fallot may be improved. The value of a severely altered LVEF appears low in the absence of other risk factors, and combination of different predictors is essential. The high rate of complications as well as consideration of competing risk situation have to be integrated in the benefit-risk equation.

scholarly journals Long-term outcome of adult survivors of tetralogy of Fallot

2021 ◽  
pp. 100147
Author(s):  
Melissa G.Y. Lee ◽  
Jessica V. Yao ◽  
Simon Binny ◽  
Marco Larobina ◽  
Peter Skillington ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Adult Survivors ◽  
Term Outcome ◽  
Long Term Outcome

Abstract 16668: Long-term Outcomes After Endo-epicardial Catheter Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Erica S Zado ◽  
Pasquale Santangeli ◽  
Francis E Marchlinski
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Substantial Improvement ◽  
Nonischemic Cardiomyopathy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Linear Ablation ◽  
Long Term Follow Up

Introduction: Endo-epicardial catheter ablation of ventricular tachycardia (VT) in patients (pts) with nonischemic cardiomyopathy (NICM) has been reported to have satisfactory results at the short- and mid-term follow-up. We sought to determine the outcomes at the long-term follow-up of endo-epicardial ablation of VT in NICM. Hypothesis: Catheter ablation provides satisfactory long term outcome Methods: We prospectively enrolled 128 pts (age 59±13 years, 116 [91%] males) with NICM who underwent endo-epicardial radiofrequency catheter ablation at our Institution. After substrate mapping, all critical sites for the clinical or induced VT(s), identified with activation, entrainment or pace-mapping, together with late, split and fractionated potentials were targeted with focal and/or linear ablation. The procedural endpoint was noninducibility of sustained monomorphic VT. Pts were followed with ICD interrogation. Results: A total of 108 (73%) pts had idiopathic dilated NICM. The remaining 20 (14%) pts had hypertrophic CM (n=11), suspected inflammatory CM (n=6), or valvular CM (n=3). The mean LV ejection fraction was 33±15%. After a mean follow-up of 19 months (max 97 months), a total of 36 (28%) pts died and 17 (13%) underwent heart transplant. Cumulative survival free from any recurrent VT was 53% (68/128 patients) (Figure A). In the remaining 60 (47%) patients with VT recurrences, catheter ablation still resulted in a significant beneficial clinical impact on VT burden, with 25/60 (42%) having only isolated (1-2) VT episodes over follow-up, and a striking reduction of VT storm in the remaining pts (Figure B). Conclusions: In patients with NICM and VT, endo-epicardial substrate-based ablation is effective in achieving long-term freedom from any VT in 53% of patients, with a substantial improvement in VT burden in many of the remaining patients.

scholarly journals Low power ablation for left coronary cusp ventricular tachycardia—Efficacy and long-term outcome

2018 ◽  
Vol 70 ◽  
pp. S384-S388 ◽  
Author(s):  
Kabilan S. Jagadheesan ◽  
Santhosh Satheesh ◽  
Ajith Ananthakrishna Pillai ◽  
Balachander Jayaraman ◽  
Raja J. Selvaraj
Keyword(s):  
Ventricular Tachycardia ◽  
Low Power ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Coronary Cusp

Long-Term Outcome After Catheter Ablation for Left Posterior Fascicular Ventricular Tachycardia Without Development of Left Posterior Fascicular Block

2012 ◽  
Vol 23 (11) ◽  
pp. 1179-1184 ◽  
Author(s):  
ERIK WISSNER ◽  
S YAMKUMAR DIVAKARA MENON ◽  
ANDREAS METZNER ◽  
BAS SCHOONDERWOERD ◽  
DIETER NUYENS ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Left Posterior
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