The Role of Ablation in Prevention of Recurrent Implantable Cardioverter Defibrillator Shocks in Patients With Tetralogy of Fallot

Kawada, Satoshi; Chakraborty, Praloy; Downar, Eugene; Sánchez, A. Porta; Sathananthan, Gnalini; Bhaskaran, Abhishek; Kugamoorthy, Priyanka; Albertini, Lisa; Oechslin, Erwin; Silversides, Candice; Wald, Rachel M.; Roche, S. Lucy; Swan, Lorna; Alonso‐Gonzalez, Rafael; Thorne, Sara; Harris, Louise; Hickey, Edward; Nanthakumar, Kumaraswamy; Mondésert, Blandine; Khairy, Paul; Nair, Krishnakumar

doi:10.1016/j.cjco.2021.01.005

Cited by 6 publications

(5 citation statements)

References 30 publications

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“…In TOF patients with ICDs implanted for SCD prevention, >80% of appropriate shocks are delivered for monomorphic VT [70,71]. ICDs can effectively terminate ventricular arrhythmias but do not prevent them and, as mentioned above, have an increased risk of complications.…”

Section: Ablation Of Vtmentioning

confidence: 99%

“…A minority of patients exhibit an alternative source of VT, such as conduction bundles or focal sites within the left or right outflow tracts that are also amenable to ablation [52]. Several studies have demonstrated that radiofrequency catheter ablation reduces the risk of VA, ICD shocks, and SCD in patients with sustained VT [70,71]. Moreover, the 12 lead VT ECG was shown to be a noninvasive predictor of the involved AI: most RBBB VTs were due to clockwise activation of AI3 while most LBBB VTs were due to clockwise activation of AI3 if precordial transition was <V5 while a transition of ≥V5 was due to AI1 or AI3 involvement [72].…”

Section: Ablation Of Vtmentioning

confidence: 99%

“…Since Isthmus 1 (mean length 3.9 ± 1.08; thickness 1.5 ± 0.3 cm) is usually broad and more challenging to transect with catheter ablation, Isthmus 3 (mean length, 1.4 ± 0.8; thickness, 0.6 ± 0.2 cm) may be considered a preferred ablation target for this circuit [74]. Outcomes of catheter ablation are generally favorable, with success rates of 70-80% acutely [71]. When catheter ablation fails, it may be attributed to inaccessible tissue (due to overlying material such as prosthetic valves or patches), hypertrophied myocardium, or pulmonary conduits attached to the outlet septum [13].…”

Section: Ablation Of Vtmentioning

confidence: 99%

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Evaluation and Management of Sudden Death Risk in Repaired Tetralogy of Fallot

Habib,

Srivasthan,

El Masry

2023

JPM

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Although substantial progress has been made to prevent sudden cardiac death in repaired tetralogy of Fallot patients, ventricular arrhythmia and sudden death continue to be major causes of morbidity and mortality in these patients. Greater survival in contemporary cohorts has been attributed to enhanced surgical techniques, more effective management of heart failure, and increased efforts in risk stratification and management of ventricular arrhythmias. More recently, our understanding of predictive risk factors has evolved into personalized risk prediction tools that rely on comprehensive demographic, imaging, functional, and electrophysiological data. However, the universal applicability of these different scoring systems is limited due to differences between study cohorts, types of anatomic repair, imaging modalities, and disease complexity. Noninvasive risk stratification is critical to identify those who may derive benefit from catheter ablation or cardioverter defibrillator implantation for primary prevention. Ultimately, assessment and risk stratification by a multidisciplinary team is crucial to analyze the various complex factors for every individual patient and discuss further options with patients and their families.

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Section: Ablation Of Vtmentioning

confidence: 99%

Section: Ablation Of Vtmentioning

confidence: 99%

Section: Ablation Of Vtmentioning

confidence: 99%

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Evaluation and Management of Sudden Death Risk in Repaired Tetralogy of Fallot

Habib,

Srivasthan,

El Masry

2023

JPM

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“…38 Role of Ablation for Secondary Treatment of Clinical VT Among patients with repaired TOF implanted with an ICD for secondary prevention, the proportion of those who received the device for a nonfatal monomorphic VT exceeds 70%. 14,38 In patients with ICDs, >80% of appropriate therapies are delivered for monomorphic VT. 14,74 ICDs effectively terminate but do not prevent VA and come with complications such as high rates of inappropriate ICD shocks, lead dysfunction, and infection. 2,38 Despite the availability of antitachycardia pacing, ≈40% of patients require ICD shocks to terminate the predominantly fast VTs (median VT cycle length, 290 milliseconds).…”

Section: Icd Complicationsmentioning

confidence: 99%

“…Radiofrequency catheter ablation is an important adjunctive treatment option to control recurrent monomorphic VT and to prevent ICD shocks. 37,[74][75][76][77] The dominant VT substrate, namely SCAI, can be identified during stable rhythm without the need for VT induction. Accordingly, despite hemodynamic intolerance, isthmus-dependent VTs can be ablated with low rates of VT recurrence if conduction block in the isthmus is achieved.…”

Section: Icd Complicationsmentioning

confidence: 99%

Arrhythmias in Repaired Tetralogy of Fallot: A Scientific Statement From the American Heart Association

Krieger¹,

Zeppenfeld²,

DeWitt³

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Arrhythmia and sudden cardiac death remain common in repaired tetralogy of Fallot and affect even those with excellent anatomic repairs. Atrial arrhythmia often has mechanisms different from those in acquired heart disease. Ventricular arrhythmia remains a major source of mortality in repaired tetralogy of Fallot. Noninvasive risk stratification is important to identify patients who may benefit from ablation or primary prevention implantable cardioverter defibrillators. Multiple noninvasive risk factors are associated with ventricular arrhythmia, but no universally accepted risk stratification algorithm exists. The mechanism of ventricular arrhythmia is usually attributable to a consistent and discrete set of slowly conducting anatomic isthmuses related to both the native anatomy and the consequences of the surgical repair, which interact with ventricular remodeling to provide arrhythmic substrate. This substrate can be identified during electroanatomic mapping and prophylactically ablated in appropriate patients. This scientific statement discusses the mechanisms and treatment of arrhythmia in repaired tetralogy of Fallot.

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Long‐term outcomes of ventricular tachycardia ablation in repaired tetralogy of Fallot: Systematic review and meta‐analysis

Prana Jagannatha,

Mendel,

Labi

et al. 2024

Journal of Arrhythmia

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BackgroundVentricular tachycardia (VT) remains a risk in repaired Tetralogy of Fallot (rTOF); however, long‐term benefits of VT ablation have not been established. This study compares the outcomes of rTOF patients with and without VT ablation.MethodsWe searched multiple databases examining the outcomes of rTOF patients who had undergone VT ablation compared to those without ablation. Primary outcomes were VT recurrence, sudden cardiac death (SCD), and all‐cause mortality. Subgroup analysis was conducted based on the type of ablation (catheter and surgical). Slow‐conducting anatomical isthmus (SCAI)‐based catheter ablation (CA) was also analyzed separately. The secondary outcome was the risk factors for the pre‐ablation history of VT.ResultsFifteen cohort studies with 1459 patients were included, 21.4% exhibited VTs. SCAI was found in 30.4% of the population, with 3.7% of non‐inducible VT. Factors significantly associated with VT before ablation included a history of ventriculostomy, QRS duration ≥180 ms, fragmented QRS, moderate to severe pulmonary regurgitation, high premature ventricular contractions burden, late gadolinium enhancement, and SCAI. Ablation was only beneficial in reducing VTs recurrence in SCAI‐based CA (risk ratio (RR) 0.11; 95% CI 0.03 to 0.33. p < 0.001; I2 = 0%) with no recurrence in patients with preventive ablation (mean follow‐up time 91.14 ± 77.81 months). The outcomes of VT ablation indicated a favorable trend concerning SCD and all‐cause mortality (RR 0.49 and 0.44, respectively); however, they were statistically insignificant.ConclusionsSCAI‐based CA has significant advantages in reducing VT recurrence in rTOF patients. Risk stratification plays a key role in determining the decision to perform ablation.

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The Role of Ablation in Prevention of Recurrent Implantable Cardioverter Defibrillator Shocks in Patients With Tetralogy of Fallot

Cited by 6 publications

References 30 publications

Evaluation and Management of Sudden Death Risk in Repaired Tetralogy of Fallot

Evaluation and Management of Sudden Death Risk in Repaired Tetralogy of Fallot

Arrhythmias in Repaired Tetralogy of Fallot: A Scientific Statement From the American Heart Association

Long‐term outcomes of ventricular tachycardia ablation in repaired tetralogy of Fallot: Systematic review and meta‐analysis

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