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Prana Jagannatha GN, Mendel B, Labi NPT, Aji WC, Kosasih AM, Adrian J, de Liyis BG, Pertiwi PFK, Antara IMPS. Long-term outcomes of ventricular tachycardia ablation in repaired tetralogy of Fallot: Systematic review and meta-analysis. J Arrhythm 2024; 40:935-947. [PMID: 39139861 PMCID: PMC11317698 DOI: 10.1002/joa3.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/24/2024] [Accepted: 05/29/2024] [Indexed: 08/15/2024] Open
Abstract
Background Ventricular 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. Methods We 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. Results Fifteen 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. Conclusions SCAI-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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Affiliation(s)
| | - Brian Mendel
- Department of Cardiology and Vascular MedicineSultan Sulaiman Government HospitalSerdang BedagaiNorth SumatraIndonesia
| | | | - Wingga Chrisna Aji
- Faculty of MedicineMuhammadiyah Yogyakarta UniversityYogyakartaIndonesia
| | - Anastasya Maria Kosasih
- Faculty of MedicineUdayana University, Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - Jonathan Adrian
- Faculty of MedicineUdayana University, Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - Bryan Gervais de Liyis
- Faculty of MedicineUdayana University, Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - Putu Febry Krisna Pertiwi
- Faculty of MedicineUdayana University, Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - I Made Putra Swi Antara
- Division of Electrophysiology and Cardiac Pacing, Department of Cardiology and Vascular Medicine, Faculty of MedicineUdayana University, Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
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Moore JP, Aboulhosn JA, Zeppenfeld K, Waldmann V, Bessière F, Blom NA, Combes N, Fish FA, McLeod CJ, Kanter RJ, Tan W, Patel N, von Alvensleben JC, Kamp A, Lloyd MS, Anderson CC, Tan RB, Mariucci E, Levi DS, Salem M, Shivkumar K, Khairy P. Rationale and Design of the Multicenter Catheter Ablation of Ventricular Tachycardia Before Transcatheter Pulmonary Valve Replacement in Repaired Tetralogy of Fallot Study. Am J Cardiol 2023; 204:14-21. [PMID: 37536198 DOI: 10.1016/j.amjcard.2023.07.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
Patients with repaired tetralogy of Fallot are at elevated risk for ventricular arrhythmia and sudden cardiac death. Over the past decade, the pathogenesis and natural history of ventricular tachycardia has become increasingly understood, and catheter ablation has emerged as an effective treatment modality. Concurrently, there has been great progress in the development of a versatile array of transcatheter valves that can be placed in the native right ventricular outflow tract for the treatment of long-standing pulmonary regurgitation. Although such valve platforms may eliminate the need for repeat cardiac operations, they may also impede catheter access to the myocardial substrates responsible for sustained macro-reentrant ventricular tachycardia. This manuscript provides the rationale and design of a recently devised multicenter study that will examine the clinical outcomes of a uniform, preemptive strategy to eliminate ventricular tachycardia substrates before transcatheter pulmonary valve implantation in patients with tetralogy of Fallot.
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Affiliation(s)
- Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Victor Waldmann
- Paris Cardiovascular Research Center (PARCC), Institut national de la santé et de la recherche médicale (Inserm), Université Paris Cité, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit; M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Francis Bessière
- Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France; Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, Lyon, France
| | - Nico A Blom
- Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicolas Combes
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France; University of Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut national de la santé et de la recherche médicale (Inserm), CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Frank A Fish
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ronald J Kanter
- Nicklaus Children's Hospital, Miami, Florida; Duke University School of Medicine, Durham, North Carolina
| | - Weiyi Tan
- Adult Congenital Heart Disease, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nimesh Patel
- Adult Congenital Heart Disease, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Anna Kamp
- The Heart Center, Nationwide Children's Hospital, the Ohio State University, Columbus, Ohio
| | - Michael S Lloyd
- Department of Cardiac Electrophysiology, Emory University, Atlanta, Georgia
| | - Charles C Anderson
- Center for Congenital Heart Disease, Providence Sacred Heart Children's Hospital, Spokane, Washington
| | - Reina B Tan
- Division of Cardiology, Hassenfeld Children's Hospital, NYU Langone Health, New York, New York
| | - Elisabetta Mariucci
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Daniel S Levi
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Morris Salem
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Que, Canada
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3
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Chiu SN, Chen YS, Hsu CC, Hua YC, Tseng WC, Lu CW, Lin MT, Chen CA, Wu MH, Chen YT, Chien TCH, Tseng CL, Wang JK. Changes of ECG parameters after BNT162b2 vaccine in the senior high school students. Eur J Pediatr 2023; 182:1155-1162. [PMID: 36602621 PMCID: PMC9813456 DOI: 10.1007/s00431-022-04786-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 01/06/2023]
Abstract
The purpose of this study is to determine the ECG parameter change and the efficacy of ECG screening for cardiac adverse effect after the second dose of BNT162b2 vaccine in young population. In December 2021, in cooperation with the school vaccination system of Taipei City government, we performed a ECG screening study during the second dose of BNT162b2 vaccines. Serial comparisons of ECGs and questionnaire survey were performed before and after vaccine in four male-predominant senior high schools. Among 7934 eligible students, 4928 (62.1%) were included in the study. The male/female ratio was 4576/352. In total, 763 students (17.1%) had at least one cardiac symptom after the second vaccine dose, mostly chest pain and palpitations. The depolarization and repolarization parameters (QRS duration and QT interval) decreased significantly after the vaccine with increasing heart rate. Abnormal ECGs were obtained in 51 (1.0%) of the students, of which 1 was diagnosed with mild myocarditis and another 4 were judged to have significant arrhythmia. None of the patients needed to be admitted to hospital and all of these symptoms improved spontaneously. Using these five students as a positive outcome, the sensitivity and specificity of this screening method were 100% and 99.1%, respectively. Conclusion: Cardiac symptoms are common after the second dose of BNT162b2 vaccine, but the incidences of significant arrhythmias and myocarditis are only 0.1%. The serial ECG screening method has high sensitivity and specificity for significant cardiac adverse effect but cost effect needs further discussed. What is Known: • The incidence of cardiac adverse effects was reported to be as high as 1.5 per 10 000 persons after the second dose BNT162b2 COVID-19 vaccine in the young male population based on the reporting system. What is New: • Through this mass ECG screening study after the second dose of BNT162b2 vaccine we found: (1) The depolarization and repolarization parameters (QRS duration and QT interval) decreased significantly after the vaccine with increasing heart rate; (2) the incidence of post-vaccine myocarditis and significant arrhythmia are 0.02% and 0.08%; (3) The serial ECG screening method has high sensitivity and specificity for significant cardiac adverse effect.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chia-Chen Hsu
- Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan
- Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan
| | - Yu-Chuan Hua
- Cardiac Children's Foundation Taiwan, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | | | | | | | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
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Eitoku T, Nishii N, Morita H, Kasahara S. A rare case of tetralogy of Fallot with catecholaminergic polymorphic ventricular tachycardia. HeartRhythm Case Rep 2022; 9:152-155. [PMID: 36970376 PMCID: PMC10030305 DOI: 10.1016/j.hrcr.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Takahiro Eitoku
- Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
- Address reprint requests and correspondence: Dr Takahiro Eitoku, Department of Pediatrics, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan.
| | - Nobuhiro Nishii
- Department of Cardiovascular therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Wu MH, Wang JK, Chiu SN, Lu CW, Lin MT, Chen CA, Tseng WC. Long-term outcome of repaired tetralogy of Fallot: Survival, tachyarrhythmia, and impact of pulmonary valve replacement. Heart Rhythm 2022; 19:1856-1863. [PMID: 35781043 DOI: 10.1016/j.hrthm.2022.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pulmonary valve replacement (PVR) is recommended for severe pulmonary regurgitation in repaired tetralogy of Fallot (rTOF). OBJECTIVE The purpose of this study was to investigate the event rate and effectiveness of PVR. METHODS A retrospective study of tetralogy of Fallot patients who survived total repair from 1970 to 2020 was conducted. RESULTS We identified 1744 rTOF patients; 86.6% with classic rTOF, 11.5% with pulmonary atresia, 0.8% with endocardial cushion defect, and 1.1% with absent pulmonary valve. Annual risks of tachyarrhythmia/sudden cardiac arrest (SCA) increased to 0.295% and 1.338% in patients aged 10-30 and 30-60 years, respectively, without sex predominance. PVR (223 surgical and 39 percutaneous) event rate was 34.7% ± 2.1% by 30 years after repair (annual risk: 1.57% between 10 and 30 years after repair). The second PVR rate was 9.9% ± 4.1% by 20 years after the first PVR. Tachyarrhythmia/SCA risk was higher in PVR patients than in No PVR patients and was reduced in PVR patients without tachyarrhythmia/SCA before PVR. However, survival in patients with ventricular tachyarrhythmia/SCA still was better after PVR. At PVR, 13% of patients had tachyarrhythmia/SCA, which was the major predictor of events after PVR. Before PVR, although the ventricular tachyarrhythmia/SCA risks included QRS duration >160 ms and New York Heart Association functional class III or IV, supraventricular tachyarrhythmia was associated with PVR age ≥28 years and N-terminal pro-brain natriuretic peptide >450 pg/mL. CONCLUSION Tachyarrhythmia/SCA occurrence and the need for PVR increased with age during young adulthood. PVR reduced subsequent arrhythmias only in those patients without arrhythmias before PVR.
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Affiliation(s)
- Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Sheunn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Tseng WC, Huang CN, Chiu SN, Lu CW, Wang JK, Lin MT, Chen CA, Wu MH. Long-term outcomes of arrhythmia and distinct electrophysiological features in congenitally corrected transposition of the great arteries in an Asian cohort. Am Heart J 2021; 231:73-81. [PMID: 33098810 DOI: 10.1016/j.ahj.2020.10.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
Congenitally corrected transposition of the great arteries (ccTGA) is associated with various types of arrhythmia, including supraventricular tachycardia (SVT) and complete atrioventricular block (cAVB). Our study aims to characterize the arrhythmia burden, associated risk factors, arrhythmia mechanisms, and the long-term follow-up results in patients with ccTGA in a large Asian cohort. METHODS We enrolled 104 patients (43 women and 61 men) diagnosed with ccTGA at our institution. The mean age at last follow-up was 20.8 years. RESULTS For 40 patients (38%) with tachyarrhythmia, paroxysmal SVT (PSVT) and atrial arrhythmia were observed in 17 (16%) and 27 (26%) patients, respectively, with 4 patients (4%) having both types of SVT. The 20-year and 30-year SVT-free survival rates were 68% and 54%, respectively. Seven patients (7%) developed cAVB: 2 (2%) developed spontaneously, and the other 5 (5%) was surgically complicated (surgical risk of cAVB: 7%, all associated with ventricular septal defect repair surgery). PSVT was mostly associated with accessory pathways (5/9) but also related to twin atrioventricular nodal reentry tachycardia (3/9) and atrioventricular nodal reentry tachycardia (1/9). Most of the accessory pathways were located at tricuspid valve (9/10). Catheter ablation successfully eliminated all PSVT substrates (10/10) and most of the atrial arrhythmia substrates (3/5), with low recurrence rate. CONCLUSIONS The arrhythmia burden in patients with ccTGA is high and increases over time. However, cAVB incidence was relatively low and kept stationary in this Asian cohort. The mechanisms of SVT are complicated and can be controlled through catheter ablation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/surgery
- Atrioventricular Block/epidemiology
- Atrioventricular Block/mortality
- Atrioventricular Block/physiopathology
- Atrioventricular Block/surgery
- Child
- Child, Preschool
- Congenitally Corrected Transposition of the Great Arteries/epidemiology
- Congenitally Corrected Transposition of the Great Arteries/mortality
- Congenitally Corrected Transposition of the Great Arteries/physiopathology
- Congenitally Corrected Transposition of the Great Arteries/surgery
- Electrocardiography
- Female
- Follow-Up Studies
- Heart Septal Defects, Ventricular/surgery
- Humans
- Incidence
- Infant
- Male
- Middle Aged
- Risk Factors
- Survival Rate
- Tachycardia, Atrioventricular Nodal Reentry/epidemiology
- Tachycardia, Atrioventricular Nodal Reentry/mortality
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/mortality
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Taiwan
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No. 1 Jen Ai Rd Section 1, Taipei City, Taiwan
| | - Chi-Nan Huang
- Department of Pediatrics, Taipei, City Hospital Heping Fuyou Branch, No. 12, Fuzhou St, Zhongzheng District, Taipei City, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan.
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital. No. 7, Chung-Shen South Rd, Taipei City, Taiwan
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Risk Factors for Mortality and Ventricular Tachycardia in Patients With Repaired Tetralogy of Fallot: A Systematic Review and Meta-analysis. Can J Cardiol 2020; 36:1815-1825. [DOI: 10.1016/j.cjca.2020.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/14/2020] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
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Abstract
Torsades de pointes is a kind of life-threatening ventricular tachyarrhythmia. We report a case of torsades de pointes in an 8-year-old boy with acute rejection after orthotopic heart transplantation. The causes of torsades de pointes could be either congenital or acquired. In this case, various causes including acute rejection-related repolarisation heterogeneity, dose-dependent acquired long QT resulting from treatment with immunosuppressants, and AKAP9 (A-kinase anchoring protein 9) genetic variants are the possible mechanisms.
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9
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Vonder Muhll IF. Timing and Results of Pulmonary Valve Replacement for Pulmonary Regurgitation in Repaired Tetralogy of Fallot: A Challenge for Evidence-Based Medicine. Can J Cardiol 2019; 35:1620-1622. [DOI: 10.1016/j.cjca.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 02/02/2023] Open
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Mongeon FP, Ben Ali W, Khairy P, Bouhout I, Therrien J, Wald RM, Dallaire F, Bernier PL, Poirier N, Dore A, Silversides C, Marelli A. Pulmonary Valve Replacement for Pulmonary Regurgitation in Adults With Tetralogy of Fallot: A Meta-analysis-A Report for the Writing Committee of the 2019 Update of the Canadian Cardiovascular Society Guidelines for the Management of Adults With Congenital Heart Disease. Can J Cardiol 2019; 35:1772-1783. [PMID: 31813508 DOI: 10.1016/j.cjca.2019.08.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/11/2019] [Accepted: 08/16/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is no systematic evidence review of the long-term results of surgical pulmonary valve replacement (PVR) dedicated to adults with repaired tetralogy of Fallot (rTOF) and pulmonary regurgitation. METHODS Our primary objective was to determine whether PVR reduced long-term mortality in adults with rTOF compared with conservative therapy. Secondary objectives were to determine the postoperative incidence rate of death, the changes in functional capacity and in right ventricular (RV) volumes and ejection fraction after PVR, and the postoperative incidence rate of sustained ventricular arrhythmias. A systematic search of multiple databases for studies was conducted without limits. RESULTS No eligible randomized controlled trial or cohort study compared outcomes of PVR and conservative therapy in adults with rTOF. We selected 10 cohort studies (total 657 patients) reporting secondary outcomes. After PVR, the pooled incidence rate of death was 1% per year (95% confidence interval [CI] 0-1% per year) and the pooled incidence rate of sustained ventricular arrhythmias was 1% per year (95% CI 1%-2% per year). PVR improved symptoms (odds ratio for postoperative New York Heart Association functional class > II 0.08, 95% CI 0.03-0.24). Indexed RV end-diastolic (-61.29 mL/m2, -43.64 to -78.94 mL/m2) and end-systolic (-37.20 mL/m2, -25.58 to -48.82 mL/m2) volumes decreased after PVR, but RV ejection fraction did not change (0.19%, -2.36% to 2.74%). The effect of PVR on RV volumes remained constant regardless of functional status. CONCLUSION Studies comparing PVR and conservative therapy exclusively in adults with rTOF are lacking. After PVR, the incidence rates of death and ventricular tachycardia are both 1 per 100 patient-years. Pooled analyses demonstrated an improved functional status and a reduction in RV volumes.
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Affiliation(s)
- François-Pierre Mongeon
- Adult Congenital Heart Center, Department of Specialized Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
| | - Walid Ben Ali
- Department of surgery, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Department of Specialized Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Ismail Bouhout
- Department of surgery, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Judith Therrien
- Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Rachel M Wald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Frederic Dallaire
- Division of Pediatric and Fetal Cardiology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Pierre-Luc Bernier
- Department of surgery, McGill University Health Center, McGill University, Montréal, Québec, Canada
| | - Nancy Poirier
- Department of surgery, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Department of surgery, CHU-Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Annie Dore
- Adult Congenital Heart Center, Department of Specialized Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Candice Silversides
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease (MAUDE Unit), McGill University, Montréal, Québec, Canada
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11
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Chuang CM, Chung FP, Lee PC, Chen SA. Successful Ablation of Ventricular Tachycardia in Repaired Tetralogy of Fallot via Transjugular and Subclavian Approach. ACTA CARDIOLOGICA SINICA 2019; 35:433-436. [PMID: 31371906 DOI: 10.6515/acs.201907_35(4).20190320a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chieh-Mao Chuang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei.,Division of Pediatric Cardiology, China Medical University Children's Hospital, China Medical University, Taichung
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Pi-Chang Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei.,Division of Pediatric Cardiology, China Medical University Children's Hospital, China Medical University, Taichung
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Egbe AC, Vallabhajosyula S, Akintoye E, Deshmukh A. Cardiac Implantable Electronic Devices in Adults with Tetralogy of Fallot. Am J Cardiol 2019; 123:1999-2001. [PMID: 30961908 DOI: 10.1016/j.amjcard.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 12/20/2022]
Abstract
Patient with repaired tetralogy of Fallot (TOF) sometimes require cardiac implantable electronic devices (CIED) for tachy/bradyarrhythmias. There are no population-based studies of CIED-related outcomes in the adult TOF population. We reviewed the Nationwide/National Inpatient Sample to determine trends in CIED-related admissions in adults with TOF repair. This is a retrospective review of the Nationwide/National Inpatient Sample database from January 1, 2000 to December 31, 2014. There were 18,353 admissions in adults with TOF diagnosis, and of these, CIED were implanted in 792 (4.3%) admissions (CIED-related admissions). Of these 792 CIED-related admissions, pacemakers were implanted in 242 (30.7%) yielding an incidence of 1.3% and implantable cardioverter-defibrillators were implanted in 550 (69.4%) yielding an incidence of 3.0%. In-hospital mortality occurred in 14 (1.8%) of the CIED-related admissions. The mean hospital length of stay was 7.7 ± 1.3 days and inflation-adjusted hospitalization cost was $141,860 ± $127,516. In 5-year intervals (2000 to 2004, 2005 to 2009, and 2010 to 2014), there was a temporal increase in the incidence of CIED-related admissions (3.7% vs 4.4% vs 4.9%, p = 0.006). There was a similar trend in the age at the time of implantation (37.7 ± 14.2 vs 38.2 ± 13.1 vs 39.0 ± 14.5 years, p < 0.001) and Charlson Comorbidity Index (1.1 ± 1.4 vs 1.4 ± 1.8 vs 1.3 ± 1.7, p < 0.001). In conclusion, the incidence of CIED-related admissions was 4.3% and increased over time. Further studies are required to determine if the observed temporal increase in incidence of CIED implantations (particularly implantable cardioverter-defibrillators) is associated with a concomitant increase in incidence of aborted sudden cardiac death.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota.
| | | | - Emmanuel Akintoye
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinic, Iowa
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota
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Modern Technology for Prevention of Sudden Cardiac Death – a Clinical Update on Device Therapy in Children with Congenital Heart Diseases. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2018-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Sudden cardiac death in children is one of the most devastating conditions that can be encountered in acute cardiac care. Intracardiac device therapy, providing prompt and effective treatment in malignant ventricular arrhythmia or in severe conduction abnormalities, is a promising tool to reduce the incidence of this fatal condition. However, the implementation of device-based therapy in the pediatric population is currently limited by the lack of clinical studies on large number of subjects. As a result, indications for device therapy in pediatric patients are still unclear in many circumstances. There are also several particularities related to device implantation in pediatric age, such as the somatic growth leading to a mismatch between chamber size and lead length, or the difficulties of implantation technique in children with small body weight. This study aims to present an update on the current advantages and limitations of device-based therapy for treating severe malignant arrhythmia or conduction disorders in children at risk for sudden cardiac death.
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14
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Chiu SN, Wu MH. Renin–angiotensin–aldosterone system blockade in patients with repaired tetralogy of Fallot: When and how. Int J Cardiol 2018; 272:88-89. [DOI: 10.1016/j.ijcard.2018.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
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15
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Hörer J. Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease. Cardiovasc Diagn Ther 2018; 8:754-764. [PMID: 30740322 DOI: 10.21037/cdt.2018.10.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Today, more than two thirds of patients with congenital heart disease (CHD) are adults. Cardiac surgery plays an essential role in restoring and maintaining cardiac function, aside from evolving medical treatment and catheter-based interventions. The aim of the present publication was to describe the spectrum of operations performed on adults with CHD (ACHD) by reviewing current literature. Currently, surgery for ACHD is predominantly valve surgery, since valvular pathologies are often either a part of the basic heart defect or develop as sequelae of corrective or palliative surgery. Surgical techniques for valve repair, established in patients with acquired heart disease (non-ACHD), can often be transferred to ACHD. New valve substitutes may help to reduce the number of redo operations. Most of valve operations yield good results in terms of survival and quality of life, with the precondition that the ventricular function is preserved. Heart failure due to end-stage CHD is the most frequent cause of mortality in ACHD. However, surgical treatment by means of mechanical circulatory support (MCS) is still uncommon and the mortality exceeds the one following other operations in ACHD. Currently, different devices are used and new technical developments are in progress. However, there still is no ideal assist device available. Therefore, heart transplantation remains the only valid option for end-stage CHD. Despite higher early mortality following heart transplantation in ACHD compared to non-ACHD, the long-term survival compares favorably to non-ACHD. There is room for improvement by refining the indications, the time of listing, and the perioperative care of ACHD transplant patients. Sudden death is the second most frequent cause of mortality in ACHD. Ventricular tachycardia is the most frequent cause of sudden death followed by coronary artery anomaly. Due to the increasing awareness of physicians and the improved imaging techniques, coronary artery anomalies are coming more into the focus of cardiac surgeons. However, the reported experience is limited and it is currently difficult to provide a standardized and generally applicable recommendation for the indication and the adequate surgical technique. With the increasing age and complexity of ACHD, treatment of rhythm disturbances by surgical ablation, pacemaker or implantable cardioverter defibrillator (ICD) implantation and resynchronisation gains importance. A risk score specifically designed for surgery in ACHD is among the newest developments in predicting the outcome of surgical treatment of ACHD. This evidence-based score, derived from and validated with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database, enables comparison of risk-adjusted performance of the whole spectrum of procedures performed in ACHD and helps in understanding the differences in surgical outcomes. The score is thus a powerful tool for quality control and quality improvement. In conclusion, new developments in surgery for ACHD are currently made with regard to valve surgery, which comprises more than half of all operations in ACHD and in treatment of end-stage CHD, which still yields high mortality and morbidity.
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Affiliation(s)
- Jürgen Hörer
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis Robinson, France
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16
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Egbe AC, Miranda WR, Madhavan M, Ammash NM, Missula VR, Al-Otaibi M, Fatola A, Kothapalli S, Connolly HM. Cardiac implantable electronic devices in adults with tetralogy of Fallot. Heart 2018; 105:538-544. [PMID: 30377259 DOI: 10.1136/heartjnl-2018-314072] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tachyarrhythmias and bradyarrhythmias affect 20%-50% of adult patients with tetralogy of Fallot (TOF) and some of these patients will require cardiac implantable electronic devices (CIED) such as pacemaker and/or internal cardioverter defibrillator. METHODS The Mayo Adult Congenital Heart Disease database was queried for patients with repaired TOF and history of CIED implantation, 1990-2017. The study objectives were: (1) determine the occurrence of device-related complications defined as lead failure, lead recall, device infection and lead thrombus; and (2) determine the occurrence and risk factors for defibrillator shock. RESULTS There were 99 patients (age 46±14 years and 66 (66%) men) with CIED, and the CIEDs were 41 (41%) pacemakers and 73 (73%) defibrillators. Indication for defibrillator implantation was for primary prevention in 28 (38%) and secondary prevention in 45 (62%). Device-related complications occurred in 20 (20%) patients (lead failure 17, lead recall 4, device infection 12 and thrombus 3). Twenty-five per cent of all device infections occurred within 30 days from the time of device generator change. Annualised rates of appropriate and inappropriate shocks were 5.7% and 6.2%, respectively. The use of class III antiarrhythmic drug was protective against defibrillator shock. CONCLUSION The current study provides useful outcome data to aid patient counselling and clinical decision-making. Further studies are required to explore ways to decrease the risk of postprocedural infection after device generator change, and to determine which patients will benefit from empirical antiarrhythmic therapy as a strategy to decrease incidence of inappropriate defibrillator shock.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Naser M Ammash
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Venkata R Missula
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Mohammed Al-Otaibi
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ayotola Fatola
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Srikanth Kothapalli
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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