Sustained ventricular tachycardia after repair of tetralogy of Fallot: New electrophysiologic findings

Kugler, John D.; Pinsky, William W.; Cheatham, John P.; Hofschire, Philip J.; Mooring, Paul K.; Fleming, William H.

doi:10.1016/0002-9149(83)90359-4

Cited by 98 publications

(22 citation statements)

References 25 publications

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“…532 By the 1980s, however, the emphasis shifted away from AV block toward VT as the more common mechanism for sudden death in tetralogy patients. [533][534][535][536][537] Multiple clinical and laboratory variables have since been linked to an elevated likelihood of VT, although the predictive accuracy for all these items remains imperfect. The general picture that emerges for the high-risk tetralogy patient involves some combination of 1) long-standing palliative shunts, 2) older age at the time of definitive surgery, 3) abnormal RV hemodynamics (due to pulmonary regurgitation and/or residual outflow obstruction), 4) high-grade ectopy on Holter monitor, and 5) inducible VT at electrophysiological study.…”

Section: Recommendations For Surgery For Adults With Previous Repair mentioning

confidence: 99%

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

Warnes¹,

Williams²,

Bashore³

et al. 2008

Circulation

884

365

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Section: Recommendations For Surgery For Adults With Previous Repair mentioning

confidence: 99%

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

Warnes¹,

Williams²,

Bashore³

et al. 2008

Circulation

884

365

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“…12 Postrepair VT in the setting of TOF was originally classified as arising from both the OT and from the septal-inflow area of the RV where fractionated electrograms were commonly observed with their induction. 21,26,27 Follow-up studies based on excision of ventricular tissue at the time of arrhythmia surgery also demonstrated prominent fibrosis with subendocardial islets of surviving myocytes in the region of the RVOT. 21 The inclusion of a group of cases surviving surgical repair in the present analysis afforded an opportunity to evaluate these findings and confirm their consistent presence in the ventricular conduction isthmuses that have been more recently described in TOF.…”

mentioning

confidence: 98%

Characterization of Anatomic Ventricular Tachycardia Isthmus Pathology After Surgical Repair of Tetralogy of Fallot

Moore

Seki

Shannon

et al. 2013

Circ: Arrhythmia and Electrophysiology

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The autopsy and surgical pathology databases at UCLA were searched for cases of TOF and its major variants (including TOF with pulmonary atresia and TOF with absent pulmonary valve). Baseline demographic and clinical data were obtained from the medical records. All specimens were evaluated for the presence of naturally or surgically related anatomic isthmuses corresponding to those that have been previously described. In addition, isthmus 1 was redesignated as 1A, 12 and © 2013 American Heart Association, Inc. Original ArticleBackground-Although catheter ablation has been used to target the critical isthmuses for re-entrant monomorphic ventricular tachycardia in tetralogy of Fallot, the anatomy and histology of these regions have not been fully characterized. Autopsy hearts with tetralogy of Fallot were evaluated to clarify the pathological substrate. Methods and Results-Twenty-seven hearts with the diagnosis of tetralogy of Fallot were examined. Anatomically defined isthmuses included (1A) ventriculotomy-to-tricuspid annulus, (1B) ventriculotomy-to-ventricular septal defect patch, (2) ventriculotomy-to-pulmonary annulus, (3) pulmonary annulus-to-ventricular septal defect patch, and (4) ventricular septal defect patch-to-tricuspid annulus. Length and wall thickness were measured for all specimens, and light microscopy was performed for those surviving surgery. For subjects ≥5 years at death, isthmuses 1A and 1B were present in 88%, isthmus 2 in 25%, isthmus 3 in 94%, and isthmus 4 in 13%. Isthmus 1A had the greatest dimensions (mean length, 3.9±1.08; thickness, 1.5±0.3 cm), isthmus 1B intermediate dimensions (mean length, 2.4±0.8; thickness, 1.1±0.4 cm), and isthmuses 2, 3, and 4 the smallest dimensions (mean length, 1.5±0.5, 1.4±0.8, and 0.6±0.4 cm; thickness, 0.5±0.2, 0.6±0.2, and 0.3±0.04 cm, respectively). Histological examination (n=7) revealed increased fibrosis in anatomic isthmuses relative to nonisthmus controls. Conclusions-Consistencies in isthmus dimensions and histology are found among patients with repaired tetralogy of Fallot. Isthmus 1A is associated with the largest morphological dimensions, whereas the nearby newly described isthmus 1B is significantly smaller. Of isthmuses with the smallest dimensions, isthmus 3 is the most common. (Circ Arrhythm Electrophysiol. 2013;6:905-911.)

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“…In symptomatic patients, sustained ventricular tachycardia was induced by the programmed electrical stimulations (Carson et al 1980;Kugler et al 1983;Aizawa et al 1986). The foci of such lethal ventricular tachycardia are detected in the outflow tract or in the interventricular septum of the right ventricle which was involved either in the ventriculotomy or by the closure of interventricular septal defect (Garson et al 1983;Kugler et al 1983;Oda et al 1986).…”

Section: Discussionmentioning

confidence: 99%

“…The foci of such lethal ventricular tachycardia are detected in the outflow tract or in the interventricular septum of the right ventricle which was involved either in the ventriculotomy or by the closure of interventricular septal defect (Garson et al 1983;Kugler et al 1983;Oda et al 1986). A delay in the activation within or around the operation scar may provide a basis for the reentrant tachycardia.…”

Section: Discussionmentioning

confidence: 99%

Ventricular arrhythmias in the long-term postoperative stage of tetralogy of Fallot.

Morikawa

1987

Tohoku J. Exp. Med.

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Sustained ventricular tachycardia after repair of tetralogy of Fallot: New electrophysiologic findings

Cited by 98 publications

References 25 publications

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

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

Characterization of Anatomic Ventricular Tachycardia Isthmus Pathology After Surgical Repair of Tetralogy of Fallot

Ventricular arrhythmias in the long-term postoperative stage of tetralogy of Fallot.

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