Arrhythmias in adult patients after total correction of tetralogy of Fallot (RCD code: V-2B.0)

Abstract

Improvement of the long-term survival of patients with Tetralogy of Fallot has been observed in the last few years. Among the late complication arrhythmias are detected most frequently. The aim of this study was to estimate the frequency of atrial and ventricular arrhythmias in the group of 53 adult tetralogy patients.Mean age was 29 years, 21 patients (39,6%) were women. In 4 cases (7,5%) palliative pulmonary-systemic shunt was performed. Average age of total surgical correction was 6,55 years. Significant ventricular arrhythmias were present in 15 patients (28,3%). 9 (17%) had relevant atrial arrhythmias. Patients with atrial arrhythmia were older (35,4 vs 27,7 years). Older were also patients with ventricular arrhythmias (34,7 vs 26,4 years). Group with atrial arrhythmia used more digoxin (p=0,002) and diuretics (p = 0,021). 3 patients on oral anticoagulants had atrial flutter. Similar data was collected in group with ventricular arrhythmias (diuretics p = 0,0053). There was a high incidence of coexisting ventricular and atrial arrhythmias (p=0,0057). Left ventricular enlargement was present in patients with atrial (p = 0,002) and ventricular (p = 0,027) arrhythmias. Right atrium area and left atrium diameter were greater in group with supraventricular arrhythmias (31,6 vs 21,6 cm 2 and 40,4 vs 34,3 mm; respectively). Ventricular arrhythmias were associated with greater right (27,8 vs 21,0 cm 2 ) and left atrium areas (18,5 vs 15,1 cm 2 ).Younger age at the time of corrective surgery is associated with lower frequency of arrhythmias in adults. Arrhythmias however remain one of the most significant problems in this group of patients. Close observation in centers specialized in Grown-Up Congenital Heart Defects and management of symptoms seems to be the best option in long-term follow-up.