Radiofrequency Catheter Ablation of Right Ventricular Tachycardia Late After Repair of Congenital Heart Defects

Abstract

In patients with symptomatic or frequent ventricular tachycardia late after complete surgical repair of congenital heart defects, catheter ablation by means of radiofrequency energy is feasible and safe and thus might be taken into consideration for these patients. Short-term follow-up results are promising.

Value of Programmed Ventricular Stimulation After Tetralogy of Fallot Repair

“…Induced VT is most commonly monomorphic and macroreentrant, rotating clockwise or counterclockwise around myotomy scars or surgical patches. 20,31,32 In patients with coronary artery disease, inducible sustained polymorphic VT is considered either nonspecific or evidence of ventricular instability. 33,34 Antiarrhythmic therapy may convert inducible polymorphic VT into a more stable substrate.…”

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

“…Therefore, postoperative complete heart block should be treated by permanent pacemaker implantation, when it is confirmed not to be transient, as recommended in the guidelines of the ACC/AHA. 32 In addition, ventricular tachycardia should be treated intensively by effective medicine(s), or invasive treatments such as catheter ablation or ICD 33 implantation if medical treatment is not effective.…”

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…Finally, if VT can be induced that is slow enough to support the circulation during mapping, catheter ablation of the VT circuit may be considered on the basis of the risks and benefits to the individual patient. 171,172 Although reports of ablation for VT in ACHD patients are still limited to small series, it appears that it can be accomplished with a reasonable degree of acute success 173,174 ; however, the risk of VT recurrence after ablation is now being more clearly defined and may exceed 20%. 174 It seems wise to reserve ablation as isolated VT therapy for those CHD patients with superior hemodynamics and single circuits of slow tachycardia, and even then, to perform follow-up stimulation studies to ensure that the same or different circuits cannot be induced before dismissing the need for an implantable cardioverter defibrillator.…”