Prevention of sudden death after repair of tetralogy of fallot: Treatment of ventricular arrhythmias

Abstract

The majority of sudden deaths after repair of tetralogy of Fallot have been presumed to be due to ventricular arrhythmia; however, it remains to be demonstrated that antiarrhythmic medication reduces the incidence of sudden death. Since 1978, ventricular arrhythmias have been treated aggressively; these include any ventricular arrhythmia on routine electrocardiogram and more than 10 uniform premature ventricular complexes per hour on 24 hour electrocardiogram. A review was undertaken of 488 patients followed up for more than 1 month after repair of tetralogy of Fallot (mean follow-up time 6.1 years); 13.5% had ventricular arrhythmia on routine electrocardiogram. Ventricular arrhythmia appeared from 2 months to 21 years postoperatively (mean 7.3 years). Ventricular arrhythmias were significantly (p less than 0.01) related to: longer follow-up duration, older age at follow-up, older age at operation and higher postoperative right ventricular systolic and end-diastolic pressures. Ventricular arrhythmia on routine electrocardiogram occurred in 100% of those who later died suddenly compared with 12% of those who did not die (p less than 0.01). Treatment for ventricular arrhythmia was given to 46 patients and considered "successful" if there were fewer than 10 uniform premature ventricular complexes per hour on 24 hour electrocardiogram. A successful drug was found in 44 of the 46: 30 of 34 given phenytoin, 6 of 9 given propranolol, 1 of 7 given quinidine, 1 of 2 given disopyramide, 8 of 9 given mexiletine and 4 of 5 given amiodarone.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias Late After Repair of Tetralogy of Fallot-A Japanese Multicenter Study-

“…Previous studies have shown that the clinically important arrhythmias are associated with older age at repair, 4,8,10,[12][13][14][15] large ventriculotomy, 10 high postoperative right ventricular pressure, 8,10,[12][13][14] tricuspid and/or pulmonary regurgitation, 2,12,15-17 cardiomegaly 2,18 or long QRS duration. 2,3,18 We therefore included these parameters in the data file for the analysis of risk factors.…”

Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure gradient

“…A previous study revealed that RV systolic pressure more than 60 mmHg is a risk factor for ventricular arrhythmias and that residual RV to PA outflow gradient of more than 40 mmHg is a risk factor of SCD (19). However, other investigators suggest that the residual pressure load of RV is not a risk factor for SCD, and some studies have demonstrated that adequate RVOT obstruction might be advantageous against PR (20).…”

Sudden cardiac death in the young: cytokines and pathways

“…The cause of SCD can be surgical technical problems, ventricular dysrhythmias, aspiration and altered baroreceptor reflexes, and electrical instability resulting from postoperative anatomical modifications. Majority of SCDs after repair of tetralogy of Fallot were due to ventricular arrhythmia, which could be screened by routine electrocardiogram (ECG) in whom SCDs occur later, and successful antiarrhythmic treatment could effectively prevent from SCDs (15).…”