Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study

Ventricular arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot are devastating complications in adult survivors of early surgery, but their prediction remains difficult. We examined surgical, electrocardiographic, and late haemodynamic data, and their relation to clinical a...

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Bibliographic Details
Published in:	The Lancet (British edition) Vol. 356; no. 9234; pp. 975 - 981
Main Authors:	Gatzoulis, Michael A, Balaji, Seshadri, Webber, Steven A, Siu, Samuel C, Hokanson, John S, Poile, Christine, Rosenthal, Mark, Nakazawa, Makoto, Moller, James H, Gillette, Paul C, Webb, Gary D, Redington, Andrew N
Format:	Journal Article
Language:	English
Published:	London Elsevier Ltd 16-09-2000 Lancet Elsevier Limited
Subjects:	Adult Atrial Flutter - etiology Atrial Flutter - mortality Biological and medical sciences Cardiac arrhythmia Cardiac dysrhythmias Cardiology. Vascular system Child Cohort Studies Death, Sudden, Cardiac - etiology Electrocardiography Electrocardiography, Ambulatory Fatalities Female Heart Hemodynamics Hospital Records Humans Lesions Male Medical research Medical sciences Mortality Multivariate Analysis Patients Postoperative Complications Risk Factors Survival Rate Tachycardia, Ventricular - etiology Tachycardia, Ventricular - mortality Tetralogy of Fallot - surgery Time Factors Human Postoperative Arrhythmia Multicenter study Sudden death Cardiovascular disease Congenital disease Association Heart disease Fallot tetralogy Adolescent Risk factor Database Repair Child
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Summary:	Ventricular arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot are devastating complications in adult survivors of early surgery, but their prediction remains difficult. We examined surgical, electrocardiographic, and late haemodynamic data, and their relation to clinical arrhythmia and sudden death occurring over 10 years, in a multicentre cohort of patients with repaired tetralogy, who were alive in 1985. Of 793 patients (mean age at repair 8·2 years [SD 8], mean time from repair 21·1 years [8–7]) who entered the study, 33 patients developed sustained monomorphic ventricular tachycardia, 16 died suddenly, and 29 had new-onset sustained atrial flutter or fibrillation. Electrocardiographic markers (QRS duration, QRS rate of change between 1985 and 1995) were significantly greater in the ventricular tachycardia and sudden-death groups. Older age at repair was associated with a higher risk of sudden death and atrial tachyarrhythmia. Pulmonary regurgitation was the main underlying haemodynamic lesion for patients with ventricular tachycardia and sudden death, whereas tricuspid regurgitation was for those with atrial flutter/fibrillation. Despite adverse haemodynamics, no patient who died suddenly had undergone late reoperation. Arrhythmia and sudden death are important late sequelae for patients after repair of tetralogy of Fallot. The electrophysiological and haemodynamic substrate of sudden death resembled that of sustained ventricular tachycardia, with pulmonary regurgitation being the predominant haemodynamic lesion. Preservation or restoration of pulmonary valve function may thus reduce the risk of sudden death. Furthermore, electrocardiographic markers can help to identify patients at risk.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0140-6736 1474-547X
DOI:	10.1016/S0140-6736(00)02714-8