Risk stratification of ventricular arrhythmias in repaired tetralogy of Fallot

Rivas-Gándara, Núria; Francisco‐Pascual, Jaume; Pijuan-Domenech, Antònia; Ribera-Solé, Aida; Dos‐Subirà, Laura; Benito, Begoña; Terricabras, María; Pérez-Rodón, Jordi; Subirana, María Teresa; Santos‐Ortega, Alba; Rosés‐Noguer, Ferran; Miranda, Berta; Moya-Mitjans, Àngel; Ferreira‐González, Ignacio

doi:10.1016/j.rec.2020.12.003

Cited by 4 publications

(8 citation statements)

References 18 publications

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“…In patients with CHD, monomorphic VTs can be very fast and hemodynamically poorly tolerated, potentially leading to SD, even in patients with preserved ventricular function. In fact, in patients with repaired ToF and TGA who have implantable cardioverter-defibrillators (ICD), most appropriate therapies correspond to episodes of high-frequency monomorphic VT (72,73).…”

Section: Ventricular Arrhythmiasmentioning

confidence: 99%

“…In those patients in whom sustained monomorphic VT is induced with good hemodynamic tolerance, the identification of arrhythmogenic isthmuses for ablation can be based on electroanatomic mapping during tachycardia and entrainment maneuvers. However, complete mapping during VT is often not possible due to lack of inducibility or poor hemodynamic tolerance (72,73). In the case of patients with rToF, considering the association between the substrate identified in sinus rhythm and the induced VTs, substrate ablation can be considered with the goal of blocking conduction through the arrhythmogenic isthmuses considered (86).…”

Section: Ablationmentioning

confidence: 99%

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Tachyarrhythmias in congenital heart disease

Francisco-Pascual,

Mallofré Vila,

Santos-Ortega

et al. 2024

Front. Cardiovasc. Med.

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The prevalence of congenital heart disease (CHD) in adult patients has risen with advances in diagnostic and surgical techniques. Surgical modifications and hemodynamic changes increase the susceptibility to arrhythmias, impacting morbidity and mortality rates, with arrhythmias being the leading cause of hospitalizations and sudden deaths. Patients with CHD commonly experience both supraventricular and ventricular arrhythmias, with each CHD type associated with different arrhythmia patterns. Macroreentrant atrial tachycardias, particularly cavotricuspid isthmus-dependent flutter, are frequently reported. Ventricular arrhythmias, including monomorphic ventricular tachycardia, are prevalent, especially in patients with surgical scars. Pharmacological therapy involves antiarrhythmic and anticoagulant drugs, though data are limited with potential adverse effects. Catheter ablation is preferred, demanding meticulous procedural planning due to anatomical complexity and vascular access challenges. Combining imaging techniques with electroanatomic navigation enhances outcomes. However, risk stratification for sudden death remains challenging due to anatomical variability. This article practically reviews the most common tachyarrhythmias, treatment options, and clinical management strategies for these patients.

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Section: Ventricular Arrhythmiasmentioning

confidence: 99%

Section: Ablationmentioning

confidence: 99%

Tachyarrhythmias in congenital heart disease

Francisco-Pascual,

Mallofré Vila,

Santos-Ortega

et al. 2024

Front. Cardiovasc. Med.

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“…In contrast, the induction of polymorphic ventricular tachycardia (PVT) or ventricular fibrillation (VF) is considered a less specific finding, especially with aggressive stimulation protocols[ 53 ]. However, induction of PVT or VF may play a role in risk stratification of specific populations such as patients with repaired tetralogy of fallot[ 19 , 54 - 56 ] or BrS[ 57 , 58 ].…”

Section: Diagnostic Approach and Testmentioning

confidence: 99%

“…ECG cardiac monitoring is one of the cornerstones of the etiological diagnosis of arrhythmic syncope. In addition, there are several areas of interest other than unexplained syncope in which monitoring devices have been investigated[ 54 , 59 - 72 ]. The objective of ECG monitoring is to correlate the patient’s symptoms with the electrocardiographic recordings to reach an objective diagnosis.…”

Section: Diagnostic Approach and Testmentioning

confidence: 99%

Arrhythmic syncope: From diagnosis to management

Pascual¹,

Marchite²,

Silva³

et al. 2023

World J Cardiol

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Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.

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“…In addition to allowing for a precise diagnosis of certain arrhythmias (such as paroxysmal supraventricular tachycardias), it is possible to treat the arrhythmia with ablation during the procedure in those cases where it is indicated[ 91 - 93 ]. It also allows to evaluate other causes of syncope if present[ 9 , 10 , 94 , 95 ], and performing risk stratification in patients with structural heart disease[ 14 , 71 ]. Since it is an invasive test, it tends to be considered at the end of the diagnostic process, either in patients with a high probability of significant arrhythmia when the monitoring methods have not allowed for it to be documented, or in patients where, after documenting the clinical arrhythmia, ablation treatment is planned.…”

Section: Work-up Of Patients With Palpitationsmentioning

confidence: 99%

Cardiac monitoring for patients with palpitations

Francisco‐Pascual¹,

Cantalapiedra-Romero²,

Pérez-Rodón³

et al. 2021

WJC

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Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom associated with cardiac rhythm disorders, although there are other etiologies. For diagnosis, it is essential to be able to reliably correlate the symptoms with an electrocardiographic record allowing the identification or ruling out of a possible rhythm disorder. However, reaching a diagnosis is not always simple, given that they tend to be transitory symptoms and the patient is frequently asymptomatic at the time of assessment. In recent years, electrocardiographic monitoring systems have incorporated many technical improvements that solve several of the 24-h Holter monitor limitations. The objective of this review is to provide an update on the different monitoring methods currently available, remarking their indications and limitations, to help healthcare professionals to appropriately select and use them in the work-up of patients with palpitations.

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Risk stratification of ventricular arrhythmias in repaired tetralogy of Fallot

Cited by 4 publications

References 18 publications

Tachyarrhythmias in congenital heart disease

Tachyarrhythmias in congenital heart disease

Arrhythmic syncope: From diagnosis to management

Cardiac monitoring for patients with palpitations

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