1
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Khairy P, Dyrda K, Mondésert B, Aguilar M, Dubuc M, Cadrin-Tourigny J, Guerra PG, Raymond-Paquin A, Rivard L, Tadros R, Talajic M, Thibault B, Macle L, Roy D. Overcoming Access Challenges to Treat Arrhythmias in Patients with Congenital Heart Disease Using Robotic Magnetic-Guided Catheter Ablation. J Clin Med 2024; 13:5432. [PMID: 39336920 PMCID: PMC11431972 DOI: 10.3390/jcm13185432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/15/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024] Open
Abstract
The prevalence of congenital heart disease (CHD) has surged in recent decades, owing to a substantial reduction in mortality. As individuals with CHD age, they become increasingly susceptible to late complications including arrhythmias. These arrhythmias often arise decades after surgical intervention and significantly impact quality of life, hospitalizations, and mortality. Catheter ablation has gained widespread acceptance as a critical intervention for managing arrhythmias in patients with CHD. However, anatomical and physiological features unique to this population pose challenges to standard manual ablation procedures, potentially impacting safety and efficacy. Robotic magnetic-guided navigation (RMN) has emerged as a technological solution to address these challenges. By utilizing soft and flexible catheters equipped with magnets at their tips, RMN enables robotic steering and orientation of catheters in three-dimensional space. This technology overcomes obstacles such as distorted vascular pathways and complex post-surgical reconstructions to facilitate access to target chambers and improve maneuverability within the heart. In this review, we present an overview of the safety and efficacy evidence for RMN-guided catheter ablation in CHD patients and highlight potential advantages. Additionally, we provide a detailed case presentation illustrating the practical application of RMN technology in this population. Although the literature on RMN-guided ablation in patients with CHD remains limited, it has shown promise in achieving successful outcomes, particularly in cases where manual ablation failed or was deemed non-feasible. Further validation through large-scale prospective studies is necessary to fully ascertain the benefits of RMN technology in this patient population.
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Affiliation(s)
- Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Katia Dyrda
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Blandine Mondésert
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Martin Aguilar
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Marc Dubuc
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Peter G Guerra
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Alexandre Raymond-Paquin
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Léna Rivard
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Rafik Tadros
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Mario Talajic
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Bernard Thibault
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Laurent Macle
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Denis Roy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
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2
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Falk ZE, Aldous AM, Ito S, Moak JP. Predictors of Atrial Arrhythmia in Adults with Repaired Tetralogy of Fallot. Pediatr Cardiol 2024:10.1007/s00246-024-03436-6. [PMID: 38319318 DOI: 10.1007/s00246-024-03436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease in adults, has excellent long-term survival. However, many patients (30-45%) develop late arrhythmias. Previous studies have identified predictors of arrhythmia (atrial or ventricular) using clinical markers that predate arrhythmia onset by many years. Our objective was to develop a predictive model for incident atrial arrhythmias within two years of clinical evaluation and diagnostic testing. A single-center nested unmatched case-control study of 174 adults with repaired TOF. We included only patients with results from ECG and echocardiogram data in the required time interval (3-24 months before first arrhythmia for cases; 24 months of follow-up for controls). A predictive multivariable model for risk of incident atrial arrhythmia was developed using logistic regression with a least absolute shrinkage and selection operator (LASSO). Of 41 demographic, surgical, and diagnostic variables, six were selected as having predictive value for atrial arrhythmia based on cross validation. The factors with the greatest predictive value in decreasing order were moderate / severe tricuspid regurgitation (adjusted odds ratio (OR) 149.42), QRS fragmentation (OR 28.08), severe pulmonary regurgitation (OR 8.22), RV systolic dysfunction (OR 2.95), 1st degree AV block (OR 2.59), and age at time of surgical repair (OR 1.02). Predictors for atrial arrhythmia in our study suggested abnormal right ventricle anatomical function and electrophysiologic properties (conduction and repolarization) as the primary underlying substrate.
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Affiliation(s)
- Zachary E Falk
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Annette M Aldous
- Department of Biostatistics and Bioinformatics, George Washington University Milken Institute of Public Health, Washington, DC, USA
| | - Seiji Ito
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA
| | - Jeffrey P Moak
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
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3
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Daniels CJ. The development of adult congenital heart disease care in the United States. Curr Probl Pediatr Adolesc Health Care 2023:101400. [PMID: 37349150 DOI: 10.1016/j.cppeds.2023.101400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- Curt J Daniels
- Professor Internal Medicine and Pediatrics, USA; Dottie Dohan Hepard Professsor Cardiovascular Medicine, USA; COACH Program: olumbus Ohio Adult Congenital Heart Program, USA; Heart Disease Program, USA; Schooler Family Adult Congenital Heart Disease Fellowship Program, USA; The Ohio State University Medical Center, USA; Nationwide Children's Hospital, Columbus, Ohio, USA.
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4
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Kikano SD, Weingarten A, Sunthankar SD, McEachern W, George-Durett K, Parra DA, Soslow JH, Chew JD. Association of cardiovascular magnetic resonance diastolic indices with arrhythmia in repaired Tetralogy of Fallot. J Cardiovasc Magn Reson 2023; 25:17. [PMID: 36907898 PMCID: PMC10009941 DOI: 10.1186/s12968-023-00928-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Patients with repaired Tetralogy of Fallot (rTOF) experience a high burden of long-term morbidity, particularly arrhythmias. Cardiovascular magnetic resonance (CMR) is routinely used to assess ventricular characteristics but the relationship between CMR diastolic function and arrhythmia has not been evaluated. We hypothesized in rTOF, left ventricular (LV) diastolic dysfunction on CMR would correlate with arrhythmias and mortality. METHODS Adolescents and adults with rTOF who underwent CMR were compared to healthy controls (n = 58). Standard ventricular parameters were assessed and manual planimetry was performed to generate filling curves and indices of diastolic function. Chart review was performed to collect outcomes. Univariate and multivariable logistic regression was performed to identify outcome associations. RESULTS One-hundred sixty-seven subjects with rTOF (mean age 32 years) and 58 healthy control subjects underwent CMR. Patients with rTOF had decreased LV volumes and increased right ventricular (RV) volumes, lower RV ejection fraction (RVEF), lower peak ejection rate (PER), peak filling rate (PFR) and PFR indexed to end-diastolic volume (PFR/EDV) compared to healthy controls. Eighty-three subjects with rTOF had arrhythmia (63 atrial, 47 ventricular) and 11 died. Left atrial (LA) volumes, time to peak filling rate (tPFR), and PFR/EDV were associated with arrhythmia on univariate analysis. PER/EDV was associated with ventricular (Odds ratio, OR 0.43 [0.24-0.80], p = 0.007) and total arrhythmia (OR 0.56 [0.37-0.92], p = 0.021) burden. A multivariable predictive model including diastolic covariates showed improved prediction for arrhythmia compared to clinical and conventional CMR measures (area under curve (AUC) 0.749 v. 0.685 for overall arrhythmia). PFR/EDV was decreased and tPFR was increased in rTOF subjects with mortality as compared to those without mortality. CONCLUSIONS Subjects with rTOF have abnormal LV diastolic function compared to healthy controls. Indices of LV diastolic function were associated with arrhythmia and mortality. CMR diastolic indices may be helpful in risk stratification for arrhythmia.
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Affiliation(s)
- Sandra D Kikano
- Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA.
| | - Angela Weingarten
- Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - Sudeep D Sunthankar
- Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - William McEachern
- Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - Kristen George-Durett
- Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - David A Parra
- Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - Jonathan H Soslow
- Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - Joshua D Chew
- Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
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Vô C, Bartoletti S, Benali K, Gonzalez CM, Mondésert B, Gagnon MH, Dyrda K, Fourier A, Khairy P. Robotic magnetic-guided catheter ablation in patients with congenital heart disease: a systematic review and pooled analysis. Expert Rev Cardiovasc Ther 2023; 21:227-236. [PMID: 36852632 DOI: 10.1080/14779072.2023.2184798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Robotic magnetic navigation (RMN) has emerged as a potential solution to overcome challenges associated with catheter ablation of arrhythmias in patients with congenital heart disease (CHD). OBJECTIVES To assess safety and efficacy of RMNguided catheter ablation in patients with CHD. DESIGN AND METHODS A systematic review and pooled analysis was conducted on patients with CHD who underwent RMNguided catheter ablation. Random effects models were used to generate pooled estimates with the inverse variance method used for weighting studies. RESULTS Twentyfour nonoverlapping records included 167 patients with CHD, mean age 36.5 years, 44.6% female. Type of CHD was simple in 27 (16.2%), moderate in 32 (19.2%), and complex in 106 (63.5%). A total of 202 procedures targeted 260 arrhythmias, the most common being macroreentrant atrial circuits. The mean procedural duration was 207.5 minutes, with a mean fluoroscopy time of 12.1 minutes. The pooled acute success rate was 89.2% [95% CI (77.8%, 97.4%)]. Freedom from arrhythmia recurrence was 84.5% [95% CI (72.5%, 94.0%)] over a mean follow-up of 24.3 months. The procedural complication rate was 3.5% with no complication attributable to RMN technology. CONCLUSION RMN-guided ablation appears to be safe and effective across a variety of arrhythmia substrates and types of CHD.
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Affiliation(s)
- Christophe Vô
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Stefano Bartoletti
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Karim Benali
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Cardiology, Saint-Etienne University Hospital Center, SaintEtienne, France
| | - Cecilia M Gonzalez
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Hélène Gagnon
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Katia Dyrda
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Anne Fourier
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Paul Khairy
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
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Izumi G, Takeda A, Yamazawa H, Nagai A, Sasaki D, Sato I, Kato N, Tachibana T. Usefulness of Prolonged PR Interval to Predict Atrial Tachyarrhythmia Development Following Surgical Repair of Tetralogy of Fallot. Am J Cardiol 2022; 184:127-132. [PMID: 36127179 DOI: 10.1016/j.amjcard.2022.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/07/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Atrial tachyarrhythmias (ATAs), which may occur after tetralogy of Fallot (TOF) surgery, can cause sudden cardiac death. However, ATAs may also develop in response to electrical substrates. This study aims to examine the predictive factors for ATAs by identifying electrical substrates in the atrium obtained from 12-lead electrocardiogram in patients who underwent TOF repair. A total of 144 patients aged >15 years (median, 31.6 years) who underwent TOF repair at Hokkaido University were enrolled. We investigated the correlation between the development of ATAs with age, time interval after initial corrective surgery, brain natriuretic peptide levels, cardiac magnetic resonance parameters (right ventricular end-diastolic volume index, right ventricular end-systolic volume index, right ventricular ejection fraction, right atrial volume index, left ventricular end-diastolic volume index, left ventricular ejection fraction), and 12-lead electrocardiogram parameters (P wave maximum voltage, PR interval, QRS width, number of fragmented QRS). Of the 144 patients, 44 patients (30.6%) developed ATAs. Multivariate analysis revealed time interval after initial corrective surgery (odds ratio 6.7, 95% confidence interval 1.78 to 12.6) and PR interval (odds ratio 2.7, 95% confidence interval: 1.17 to 4.20) as independent risk factors for the development of ATAs. The receiver operating characteristic curve revealed a PR interval cut-off value of >200 milliseconds as predictive of the development of ATAs in patients more than 15 years after initial corrective surgery (area under the curve, 0.658; sensitivity, 71.4%; specificity, 66.4%). The present study demonstrated that a prolonged PR interval is a simple and convenient predictor for the development of ATAs in patients who underwent TOF repair.
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Affiliation(s)
- Gaku Izumi
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ayako Nagai
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Itsumi Sato
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyasu Kato
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
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7
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Pinsker BL, Serfas JD, Awerbach JD, Dizon S, Spector ZZ, Campbell MJ, Krasuski RA. Utility of Cardiac Magnetic Resonance Imaging in Predicting Atrial Arrhythmias in Repaired Tetralogy of Fallot. Am J Cardiol 2022; 174:151-157. [PMID: 35473783 DOI: 10.1016/j.amjcard.2022.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
Arrhythmias are the leading cause of morbidity and mortality in repaired tetralogy of Fallot (TOF), and over 20% of these patients will develop a sustained atrial arrhythmia during their lifetimes. Cardiac magnetic resonance imaging (cMRI) is frequently performed in TOF, although its ability to identify patients at risk of atrial arrhythmias is uncertain. Adult TOF patients (n = 175) with no history of atrial arrhythmia who underwent cMRI between 2003 and 2020 at a single tertiary care center were identified. Clinical characteristics and imaging findings were evaluated to identify a predilection for atrial arrhythmias using Kaplan-Meier survival analysis and log-rank testing. Multivariable Cox regression was used to determine independent predictors of atrial arrhythmias. Over a median follow-up of 3.6 years, 29 patients (17%) developed atrial arrhythmias. Independent predictors of atrial arrhythmia included age (hazard ratio [HR] 1.06 per 1-year increase, 95% confidence interval [CI] 1.02 to 1.09, p = 0.002), diabetes mellitus (HR 4.26, 95% CI 1.26 to 14.41, p = 0.020), indexed right ventricular end-diastolic volume (RVEDVi), (HR 1.20 per 10-ml/m2 increase, 95% CI 1.05 to 1.39, p = 0.010), and moderate or greater tricuspid regurgitation (TR) (HR 6.32, 95% CI 2.15 to 18.60, p = 0.001). Utilizing Kaplan-Meier analysis, patients with at least mild right ventricular dilation (RVEDVi >100 ml/m2, p = 0.047) and greater than or equal to moderate TR (p <0.001) were found to be significantly more likely to develop atrial arrhythmias. In conclusion, cMRI can help to identify TOF patients at increased risk for atrial arrhythmia beyond standard clinical and imaging data by better quantifying RVEDVi and degree of TR.
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Affiliation(s)
- Bret L Pinsker
- Duke University School of Medicine, Durham, North Carolina
| | - John D Serfas
- Division of Cardiology, Department of Internal Medicine
| | - Jordan D Awerbach
- Division of Cardiology, Phoenix Children's Hospital, Phoenix, Arizona
| | | | - Zebulon Z Spector
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Michael J Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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8
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Pinsker BL, Serfas JD, Krasuski RA. Burden and Impact of Arrhythmias in Repaired Tetralogy of Fallot. Curr Cardiol Rep 2022; 24:225-234. [PMID: 35138576 DOI: 10.1007/s11886-022-01638-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Arrhythmias are a leading cause of morbidity and mortality following repair of tetralogy of Fallot (TOF). This review will highlight current understanding of arrhythmia pathogenesis in this patient population and review novel therapeutic options. RECENT FINDINGS Risk factors for developing ventricular arrhythmias in repaired TOF have thus far been better defined than for atrial arrhythmias. Growing understanding of the pathophysiology of arrhythmias, development of risk stratification models, and novel techniques such as electrophysiologic ultrahigh-density mapping should help to better identify patients that benefit from advanced therapies such as ablation and implantable cardioverter defibrillators. Atrial and ventricular arrhythmias are common in TOF patients. Methods of risk stratification and therapeutic approaches are rapidly evolving, leading to ever improving clinical outcomes in this patient population.
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Affiliation(s)
| | - John D Serfas
- Section of Adult Congenital Heart Disease, Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Box 3012, Durham, NC, 27710, USA
| | - Richard A Krasuski
- Duke University School of Medicine, Durham, NC, USA. .,Section of Adult Congenital Heart Disease, Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Box 3012, Durham, NC, 27710, USA.
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9
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Zaidi AN. Tetralogy of Fallot: management of residual hemodynamic and electrophysiological abnormalities. Heart 2021; 108:1408-1414. [PMID: 34949687 DOI: 10.1136/heartjnl-2020-316668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ali N Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Wu M, Fan C, Liu J, Iroegbu CD, Chen W, Huang P, Tang M, Wu X, Wang C, Xiang K, Zhou W, Yang J. Clinical Application of Individualized Pulmonary Bi-Orifice for the Reconstruction of Right Ventricular Outflow Tract in Tetralogy of Fallot. Front Cardiovasc Med 2021; 8:772198. [PMID: 34901232 PMCID: PMC8661005 DOI: 10.3389/fcvm.2021.772198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The study aims to establish a new method in the Tetralogy of Fallot (ToF) called the pulmonary valve bi-orifice method (pulmonary annular sparing with an individualized autologous pericardial patch; thus, two orifices are formed at the level of the pulmonary valve annulus) to reconstruct the right ventricular outflow tract (RVOT). Methods: A retrospective analysis of 128 TOF patients from October 2009 to June 2018 with severe pulmonary valve dysplasia who underwent transvalvular annular patch (TAP) procedure (control group) or an individualized pulmonary valve bi-orifice procedure (observation group) were studied. The RVOT for each patient in the observation group was individually reconstructed per the patient's weight and the size of the autologous pulmonary valve using the bi-orifice method; however, increasing the cross-sectional area of the pulmonary valve annulus without destroying its integrity. The result was then compared to the control group, where TAP procedures were applied to evaluate the short to mid-term outcome(s). An in vitro simulation test was used to verify the anti-regurgitation mechanism of the new method. Results: The in vitro simulation test indicated that the anti-regurgitation mechanism was completed by the pericardial patch and the autologous pulmonary valve movement toward each other. Thus, for clinical applications, patients in both groups were compared. The results showed no significant differences in cardiopulmonary bypass and aortic cross-clamp time, mechanical ventilation, and ICU and post-operative residence between the two groups. During the follow-up period (3- to 12-years), 14 patients in the observation group had mild regurgitation after surgery (22.2%), while 10 patients had moderate pulmonary regurgitation (15.8%) with no right ventricular (RV) dilation. On the other hand, 22 patients (39.6%) had moderate to severe regurgitation in the control group, while left pulmonary artery stenosis occurred in one patient. In the control group, six patients (9.2%) with severe RV dilation were reoperated. Conclusion: Individualized pulmonary valve bi-orifice procedure is a safe and excellent method for reconstructing RVOT in ToF.
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Affiliation(s)
- Ming Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of the Cardiovascular Surgery, The Hunan Provincial People's Hospital, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jian Liu
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wangping Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Peng Huang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, China
| | - Mi Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xun Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chunle Wang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kun Xiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenwu Zhou
- Department of the Cardiovascular Surgery, The Hunan Provincial People's Hospital, Changsha, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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11
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Akiyama S, Kimura N, Yamazaki M, Ito T, Shimizu H. Outcomes of pulmonary valve replacement using a bioprosthetic valve and polytetrafluoroethylene bicuspid valve for pulmonary valve regurgitation after intracardiac repair of tetralogy of Fallot. J Card Surg 2021; 36:4169-4175. [PMID: 34423465 DOI: 10.1111/jocs.15940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Excellent results have been reported regarding pulmonary valve replacement (PVR) for pulmonary valve regurgitation (PR) after intracardiac repair (ICR) in patients with tetralogy of Fallot (TOF). However, there are apparently no reports comparing the following procedures: PVR using a bioprosthetic valve and PVR using a polytetrafluoroethylene (PTFE) bicuspid valve. Herein, we retrospectively analyzed the outcomes of PVR for PR after ICR of TOF in our institution and assessed which of the two PVR procedures was better. METHODS From June 2008 to December 2017, we performed PVR for PR after ICR of TOF in 34 patients. Patients with the right ventricle to the pulmonary artery conduits were excluded. Preoperative and postoperative cardiac magnetic resonance imagings (cMRIs) were performed in all patients. The patients were divided into the bioprosthetic valve group (BV group, n = 17) and the PTFE bicuspid valve group (PTFE group, n = 17). RESULTS There were no significant differences in the preoperative cMRI data and perioperative factors between the two groups. There were no deaths in either group. Postoperative cMRI showed that the PR fraction and the right ventricular end-diastolic volume index (RVEDVI)/left ventricular end-diastolic volume index ratio were significantly improved in both groups. However, RVEDVI was significantly improved only in the BV group. Re-PVR was required in four patients in the PTFE group. CONCLUSION PVR using a bioprosthetic valve was more effective for PR treatment after ICR of TOF than PVR using a PTFE bicuspid valve.
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Affiliation(s)
- Sho Akiyama
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naritaka Kimura
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Yamazaki
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Ito
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
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12
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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13
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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14
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Abstract
Approximately 50 million adults worldwide have known congenital heart disease (CHD). Among the most common types of CHD defects in adults are atrial septal defects and ventricular septal defects followed by complex congenital heart lesions such as tetralogy of Fallot. Adults with CHDs are more likely to have hypertension, cerebral vascular disease, diabetes and chronic kidney disease than age-matched controls without CHD. Moreover, by the age of 50, adults with CHD are at a greater than 10% risk of experiencing cardiac dysrhythmias and approximately 4% experience sudden death. Consequently, adults with CHD require healthcare that is two- to four-times greater than adults without CHD. This paper discusses the diagnosis and treatment of adults with atrial septal defects, ventricular septal defects and tetralogy of Fallot.
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Affiliation(s)
- Robert J Henning
- School of Public Health, University of South Florida, Tampa, FL 33612, USA
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15
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Kido T, Ueno T, Taira M, Kanaya T, Okuda N, Toda K, Kuratani T, Sawa Y. Clinical significance of right atrial volume in patients with repaired tetralogy of Fallot. Interact Cardiovasc Thorac Surg 2020; 30:296-302. [PMID: 31638655 DOI: 10.1093/icvts/ivz254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Atrial arrhythmia and right ventricular (RV) diastolic dysfunction are associated with increased morbidity and mortality in patients with repaired tetralogy of Fallot (TOF). This study was performed to determine whether the preoperative right atrial (RA) volume can predict the development of atrial arrhythmia after pulmonary valve replacement (PVR) in patients with TOF. METHODS Forty-seven consecutive adult patients with repaired TOF underwent PVR from 2003 to 2018. Seventeen patients showed preoperative atrial arrhythmia and underwent the Maze procedure concomitantly. The preoperative RA volume was evaluated with computed tomography and image analysis software. RESULTS The median follow-up period after PVR was 6.8 years. Among 17 patients who underwent the Maze procedure, recurrent atrial arrhythmia developed in 8 patients. Among 30 patients without preoperative atrial arrhythmia, novel atrial arrhythmia developed in 2 patients. The RA volume index was a significant predictor according to the multivariate analysis (P = 0.003). The RA volume index showed a significant positive correlation with the RV end-diastolic pressure (P < 0.001). CONCLUSIONS The RA volume predicts the development of atrial arrhythmia after PVR in patients with repaired TOF. RA volume measurement is strongly recommended in the management of this patient population.
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Affiliation(s)
- Takashi Kido
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Taira
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomomitsu Kanaya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Okuda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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16
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van der Ven JP, van den Bosch E, Bogers AJ, Helbing WA. Current outcomes and treatment of tetralogy of Fallot. F1000Res 2019; 8:F1000 Faculty Rev-1530. [PMID: 31508203 PMCID: PMC6719677 DOI: 10.12688/f1000research.17174.1] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 01/08/2023] Open
Abstract
Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.
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Affiliation(s)
- Jelle P.G. van der Ven
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Eva van den Bosch
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Ad J.C.C. Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Radboud UMC - Amalia Children's Hospital, Nijmegen, The Netherlands
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17
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Different characteristics of postoperative atrial tachyarrhythmias between congenital and non-congenital heart disease. J Interv Card Electrophysiol 2019; 58:1-8. [PMID: 31197584 DOI: 10.1007/s10840-019-00575-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The chance of encountering tachyarrhythmias has been increasing in adult congenital heart disease (CHD) patients with previous open-heart surgery, along with the improvement of their longevity. However, the characteristics of these arrhythmias remain to be elucidated. METHODS We examined the characteristics of atrial tachyarrhythmias (ATs) in 26 consecutive CHD patients (M/F 17/9) referred for catheter ablation and compared them with 16 non-CHD patients with cardiac surgery (M/F 11/5). RESULTS The CHD group was younger and had a longer period from cardiac surgery until the occurrence of ATs compared with the non-CHD group (44.8 ± 19.5 vs. 67.6 ± 12.5 years old, and 23.3 ± 13.2 vs. 6.3 ± 4.9 years, respectively, both P < 0.05). Multiple ATs were equally induced in both groups, 12 in CHD (46.1%) and 5 in non-CHD (31.3%). Although the prevalence of macro-reentrant ATs (cavo-tricuspid isthmus-dependent atrial flutter (AFL) or intra-atrial reentrant tachycardia (IART)) was comparable, the mechanisms were different between the 2 groups (AFL and IART), 34% and 27% in CHD and 71% and 24% in non-CHD, respectively. Furthermore, focal AT (FAT) was noted in 9 patients (34.6%) in CHD but none in non-CHD (P < 0.05). Electroanatomical mapping showed that the surface area and low-voltage area (LVA) of the right atrium were significantly larger in CHD than in non-CHD (197.1 ± 56.4 vs. 132.4 ± 41.2 cm2, and 40.8 ± 33.3 vs. 13.6 ± 9.0 cm2, respectively, both P < 0.05). Ten out of 14 FATs (71.4%) were highly associated with LVA, especially near the crista terminalis. CONCLUSIONS The development of ATs in CHD patients could be associated with large atrial remodeling, resulting in complicated ATs.
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18
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de Castilhos GM, Ley ALG, Daudt NS, Horowitz ESK, Leiria TLL. Routine Detection of Atrial Fibrillation/Flutter Predicts a Worse Outcome in a Cohort of Tetralogy of Fallot Patients During 23 Years of Follow-Up. Pediatr Cardiol 2019; 40:1009-1016. [PMID: 31062060 DOI: 10.1007/s00246-019-02106-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
Abstract
Atrial flutter/fibrillation (AFL/AF) is a late complication in adults with repaired tetralogy of Fallot (TOF). Its effects on long-term prognosis are not fully understood. We evaluate the impact of AFL/AF in adults with repaired TOF on global mortality and unplanned hospitalizations during follow-up, and the predictors for AFL/AF occurrence. The presence of AFL/FA was analysed in all exams performed during the last 10 years of outpatients follow up in a unicentric cohort of repaired TOF between 1980 and 2003. Two-hundred and six patients were included; at a mean follow-up of 21 ± 8.2 years, there were 5 deaths (19.2%) in the AFL/AF group and 2 (1.1%) in those without arrhythmia (p < 0.001). Patients with AFL/AF where older at the time of the surgical repair (p < 0.001) and had a higher rate of reinterventions (p = 0.003). No differences were observed between the groups regarding the use of a transannular patch, ventriculotomy and previous palliative shunt. QRS duration was longer in patients with AFL/AF (174 ± 33.4) when compared to those without arrhythmia (147 ± 39.6; p < 0.0001). Age at surgery, QRS duration, and tricuspid regurgitation ≥ moderate were independent risk predictors for AFL/AF. In the multivariate analysis, atrial flutter/fibrillation and QRS duration were predictors of death and hospitalization. AFL/AF is associated with an increased risk of death and hospitalization during the follow-up of patients with repaired TOF. Early detection of AFL/AF and their predictors is an essential step in the evaluation of such population.
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Affiliation(s)
- Gabriela Machado de Castilhos
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil
| | - Antonio Lessa Gaudie Ley
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil
| | - Nestor Santos Daudt
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil
| | - Estela Suzana Kleiman Horowitz
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil
| | - Tiago Luiz Luz Leiria
- Institute of Cardiology of Rio Grande Do Sul / University Foundation of Cardiology, Av. Princesa Isabel, 395, Santana, Porto Alegre, RS, CEP 90620-000, Brazil.
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19
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Kimura Y, Fukuda K, Nakano M, Hasebe Y, Fukasawa K, Chiba T, Miki K, Tatebe S, Miyata S, Ota H, Kimura M, Adachi O, Saiki Y, Shimokawa H. Prognostic Significance of PR Interval Prolongation in Adult Patients With Total Correction of Tetralogy of Fallot. Circ Arrhythm Electrophysiol 2018; 11:e006234. [PMID: 30571179 DOI: 10.1161/circep.118.006234] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several studies have demonstrated the importance of mechanoelectrical interaction in patients with surgically corrected tetralogy of Fallot. However, the significance of atrioventricular conduction disturbance, that is PR interval prolongation, on adverse cardiac events in those patients remains to be elucidated. METHODS We examined electrocardiograms at baseline and their temporal change in a total of 176 patients with repaired tetralogy of Fallot (49% men; median age, 17.4 years). Then, we evaluated their correlation with right ventricular volume and function measured by cardiac magnetic resonance and the significance as a risk factor of adverse cardiac events: lethal ventricular arrhythmias, atrial arrhythmias, heart failure hospitalization, complete atrioventricular block (AVB), and all-cause death. RESULTS First-degree AVB was noted in 25 patients (14%). During a median follow-up of 10.0 (5.0-14.2) years, there was a progressive prolongation of PR interval (2.00±3.99 ms/y). Importantly, there were significant correlations between PR interval prolongation and right ventricular enlargement or right ventricular dysfunction. In contrast, in patients who underwent pulmonary valve replacement (n=23), significant shortening of PR interval by pulmonary valve replacement was noted (204±32 versus 176±34 ms; P=0.007). Cox regression analysis showed that first-degree AVB was an independent risk factor for lethal ventricular arrhythmias (hazard ratio, 5.479; 95% CI, 1.181-25.42; P=0.030) and complete AVB (hazard ratio, 27.67; 95% CI, 4.152-184.3; P<0.001) and had a tendency for heart failure hospitalization (hazard ratio, 3.301; 95% CI, 0.864-11.80; P=0.069). In addition, PR interval prolongation >2 ms/y was also a significant risk factor for lethal ventricular arrhythmias, regardless of the presence or absence of first-degree AVB at enrollment (hazard ratio, 24.18; 95% CI, 2.080-281.1; P=0.011). CONCLUSIONS These results indicate that progressive atrioventricular conduction disturbance is correlated with right ventricular enlargement and could be a useful predictor for increased risk of lethal ventricular arrhythmias in patients with repaired tetralogy of Fallot.
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Affiliation(s)
- Yoshitaka Kimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Koji Fukuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Makoto Nakano
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Yuhi Hasebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Kyoshiro Fukasawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Takahiko Chiba
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Keita Miki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.)
| | - Satoshi Miyata
- Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (S.M., H.S.)
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan (H.O.)
| | - Masato Kimura
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan (M.K.)
| | - Osamu Adachi
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan (O.A., Y.S.)
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan (O.A., Y.S.)
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.K., K. Fukuda, M.N., Y.H., K. Fukasawa, T.C., K.M., S.T., H.S.).,Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (S.M., H.S.)
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20
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Hickey E, Pham-Hung E, Halvorsen F, Gritti M, Duong A, Wilder T, Caldarone CA, Redington A, Van Arsdell G. Annulus-Sparing Tetralogy of Fallot Repair: Low Risk and Benefits to Right Ventricular Geometry. Ann Thorac Surg 2018; 106:822-829. [DOI: 10.1016/j.athoracsur.2017.11.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
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22
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Ramdjan TT, Mouws EM, Teuwen CP, Sitorus GD, Houck CA, Bogers AJ, de Groot NM. Progression of late postoperative atrial fibrillation in patients with tetralogy of Fallot. J Cardiovasc Electrophysiol 2017; 29:30-37. [DOI: 10.1111/jce.13369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 08/31/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Elisabeth M.J.P. Mouws
- Department of Cardiology; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Cardiothoracic Surgery; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Christophe P. Teuwen
- Department of Cardiology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Gustaf D.S. Sitorus
- Department of Cardiology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Charlotte A. Houck
- Department of Cardiology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Ad J.J.C. Bogers
- Department of Cardiothoracic Surgery; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Natasja M.S. de Groot
- Department of Cardiology; Erasmus University Medical Center; Rotterdam The Netherlands
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Pilato R, Lacroix D, Domanski O, Godart F. [Pulmonary revalvulation and rhythmologenic risks in patients with repaired tetralogy of Fallot]. Presse Med 2017; 46:586-593. [PMID: 28583744 DOI: 10.1016/j.lpm.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/12/2016] [Accepted: 02/16/2017] [Indexed: 10/19/2022] Open
Abstract
Tetralogy of Fallot is a frequent congenital heart disease that has been repaired since the mid-1950s. The follow-up after repair is good despite a persistent risk of sudden death. The risk factors in long-term follow-up are advanced age at repair, hemodynamic status of the right ventricle, QRS duration≥180ms, left ventricular dysfunction, and existence of sustained or not ventricular tachycardia. In the presence of significant pulmonary regurgitation, it is necessary to perform revalvulation either by classic surgery or cardiac catheterization. To correct the risk of ventricular arrhythmia, some have proposed radiofrequency ablation of critical isthmus, or cryo-application during surgery. However, the use of implantable cardioverter defibrillator is another therapeutic option that is more and more employed as secondary or primary prevention in patients at risk of sudden death.
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Affiliation(s)
- Rosario Pilato
- CHRU de Lille, hôpital cardiologique, service des maladies cardiovasculaires infantiles et congénitales, boulevard Pr.-Leclercq, 59037 Lille cedex, France
| | - Dominique Lacroix
- University Lille, faculté de médicine, 59000 Lille, France; CHRU de Lille, hôpital cardiologique, service de cardiologie, boulevard Pr.-Leclercq, 59037 Lille cedex, France
| | | | - François Godart
- University Lille, faculté de médicine, 59000 Lille, France; CHRU de Lille, hôpital cardiologique, service de cardiologie, boulevard Pr.-Leclercq, 59037 Lille cedex, France.
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Abstract
Patients with repaired or unrepaired congenital heart anomalies are at increased risk for arrhythmia development throughout their lives, often paralleling the need for reoperations for hemodynamic residua. The ability to incorporate arrhythmia surgery into reoperations can result in improvement in functional class and decreased need for antiarrhythmic medications. Every reoperation for congenital heart disease can be viewed as an opportunity to assess the electrical and arrhythmia substrates and to intervene to improve the arrhythmias and the hemodynamic condition of the patient. The authors review and summarize the operative techniques for arrhythmia surgery that are based on the arrhythmia mechanisms.
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Affiliation(s)
- Barbara J Deal
- Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Constantine Mavroudis
- Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, 2501 N Orange Avenue, Suite 540, Orlando, FL 32804, USA
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Abstract
Subspecialty pediatric practice provides comprehensive medical care for a range of ages, from premature infants to children, and often includes adults with complex medical and surgical issues that warrant multidisciplinary care. Normal physiologic variations involving different body systems occur during sleep and these vary with age, stage of sleep, and underlying health conditions. This article is a concise review of the cardiovascular (CV) physiology and pathophysiology in children, sleep-disordered breathing (SDB) contributing to CV morbidity, congenital and acquired CV pathology resulting in SDB, and the relationship between SDB and CV morbidity in different clinical syndromes and systemic diseases in the expanded pediatric population.
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Affiliation(s)
- Grace R Paul
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Swaroop Pinto
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA
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Dennis M, Moore B, Kotchetkova I, Pressley L, Cordina R, Celermajer DS. Adults with repaired tetralogy: low mortality but high morbidity up to middle age. Open Heart 2017; 4:e000564. [PMID: 28698799 PMCID: PMC5495176 DOI: 10.1136/openhrt-2016-000564] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/22/2016] [Indexed: 12/23/2022] Open
Abstract
Objective Survival of patients with repaired tetralogy of Fallot (rToF) into young adulthood is very good. Concerns exist, however, over long-term morbidity and mortality as these subjects reach middle age. We aimed to assess survival and the prevalence of complications in patients with rToF seen in our Adult Congenital Heart Disease (ACHD) service. Methods One hundred and sixty-eight consecutive patients with ‘simple rToF’, aged over 16 years, followed up at our tertiary-level ACHD service in Sydney, Australia since 2000, were included. We documented mortality and analysed the prospectively defined composite end points of (a) ‘Serious adverse events’, including death, heart failure hospitalisation and/or documented ventricular arrhythmia and (b) ‘Adverse events’ inclusive of the above and endocarditis, atrial arrhythmia, defibrillator and/or pacemaker implantation. Results Mean age at the last follow-up was 34±12 years, and 55% were men. There were 10 (6%) deaths, and 26 patients (16%) experienced a ‘serious adverse event’. Fifty-one patients (30%) experienced an ‘adverse event’ and 29 patients had atrial arrhythmias. One hundred and one (61%) patients had at least one pulmonary valve replacement. By age 40 years, 93% were free of serious adverse events, and 83% were free of any adverse event. By age 50 years, only 56% had not had an adverse event. Older age and history of atrial arrhythmia were predictive of serious adverse events. Conclusion Survival into mid-adulthood in patients with rToF is very good; however, a substantial number of survivors have adverse events by the age of 50 years.
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Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ben Moore
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Irina Kotchetkova
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lynne Pressley
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rachael Cordina
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Timóteo AT, Branco LM, Rosa SA, Ramos R, Agapito AF, Sousa L, Galrinho A, Oliveira JA, Oliveira MM, Ferreira RC. Usefulness of right ventricular and right atrial two-dimensional speckle tracking strain to predict late arrhythmic events in adult patients with repaired Tetralogy of Fallot. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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28
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Timóteo AT, Branco LM, Rosa SA, Ramos R, Agapito AF, Sousa L, Galrinho A, Oliveira JA, Oliveira MM, Ferreira RC. Usefulness of right ventricular and right atrial two-dimensional speckle tracking strain to predict late arrhythmic events in adult patients with repaired Tetralogy of Fallot. Rev Port Cardiol 2016; 36:21-29. [PMID: 27939278 DOI: 10.1016/j.repc.2016.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/27/2016] [Accepted: 07/26/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine whether right ventricular and/or atrial speckle tracking strain is associated with previous arrhythmic events in patients with repaired tetralogy of Fallot. METHODS AND RESULTS We studied right ventricular and atrial strain in 100 consecutive patients with repaired tetralogy of Fallot referred for routine echocardiographic evaluation. Patients were divided into two groups, one with previous documentation of arrhythmias (n=26) and one without arrhythmias, in a median follow-up of 22 years. Patients with arrhythmias were older (p<0.001) and had surgical repair at an older age (p=0.001). They also had significantly reduced right ventricular strain (-14.7±5.5 vs. -16.9±4.0%, p=0.029) and right atrial strain (19.1±7.7% vs. 25.8±11.4%, p=0.001). Neither right ventricular nor right atrial strain were independent predictors of the presence of a history of documented arrhythmias, which was associated with age at correction and with the presence of residual defects. In a subanalysis after excluding 23 patients who had had more than one corrective surgery, right ventricular strain was an independent predictor of the presence of previous arrhythmic events (OR 1.19, 95% CI 1.02-1.38, p=0.025). Right atrial strain was also an independent predictor after adjustment (OR 0.93, 95% CI 0.87-0.99, p=0.029). The ideal cut-off for right ventricular strain was -15.3% and for right atrial strain 23.0%. CONCLUSIONS Compared with conventional echocardiographic parameters, strain measures of the right heart are associated with the presence of arrhythmic events, and may be useful for risk stratification of patients with repaired tetralogy of Fallot, although a prospective study is required.
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Affiliation(s)
- Ana T Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
| | - Luísa M Branco
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Sílvia A Rosa
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ruben Ramos
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ana F Agapito
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Lídia Sousa
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ana Galrinho
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - José A Oliveira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Mário M Oliveira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rui C Ferreira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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Miles S, Ahmad W, Bailey A, Hatton R, Boyle A, Collins N. Sleep-Disordered Breathing in Patients with Pulmonary Valve Incompetence Complicating Congenital Heart Disease. CONGENIT HEART DIS 2016; 11:678-682. [PMID: 27214563 DOI: 10.1111/chd.12369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Long standing pulmonary regurgitation results in deleterious effects on right heart size and function with late consequences of right heart volume overload including ventricular dilatation, propensity to arrhythmia and right heart failure. As sleep disordered breathing may predispose to elevations in pulmonary vascular resistance and associated negative effects on right ventricular function, we sought to assess this in patients with underlying congenital heart disease. DESIGN We performed a pilot study to evaluate the incidence of sleep-disordered breathing in a patient population with a history of long standing pulmonary valve incompetence in patients with congenital heart disease using overnight oximetry. PATIENTS Patients with a background of tetralogy of Fallot repair or residual pulmonary incompetence following previous pulmonary valve intervention for congenital pulmonary stenosis were included. RESULTS Twenty-two patients underwent overnight oximetry. The mean age of the cohort was 34.3 ± 15.2 years with no patients observed to have severe underlying pulmonary hypertension. Abnormal overnight oximetry was seen in 13/22 patients (59.1%) with 2/22 (9.1%) patients considered to have severe abnormalities. CONCLUSIONS An important proportion of patients with a background of pulmonary incompetence complicating congenital heart disease are prone to the development of sleep-disordered breathing as assessed by overnight oximetry. Further study into the prevalence and mechanisms of sleep-disordered breathing in a larger cohort are warranted.
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Affiliation(s)
- Susan Miles
- Department of General Medicine, John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Waheed Ahmad
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Amy Bailey
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Rachael Hatton
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Nicholas Collins
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
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Mavroudis C, Stulak JM, Ad N, Siegel A, Giamberti A, Harris L, Backer CL, Tsao S, Dearani JA, Weerasena N, Deal BJ. Prophylactic atrial arrhythmia surgical procedures with congenital heart operations: review and recommendations. Ann Thorac Surg 2014; 99:352-9. [PMID: 25442995 DOI: 10.1016/j.athoracsur.2014.07.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/03/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
Specific congenital heart anomalies significantly increase the risk for late atrial arrhythmias, raising the question whether prophylactic arrhythmia operations should be incorporated into reparative open heart procedures. Currently no consensus exists regarding standard prophylactic arrhythmia procedures. Questions remain concerning the arrhythmia-specific lesions to perform, energy sources to use, need for atrial appendectomy, and choosing a right, left, or biatrial Maze procedure. These considerations are important because prophylactic arrhythmia procedures are performed without knowing if the patient will actually experience an arrhythmia. This review identifies congenital defects with a risk for the development of atrial arrhythmias and proposes standardizing lesion sets for prophylactic arrhythmia operations.
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Affiliation(s)
- Constantine Mavroudis
- Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, Orlando, Florida.
| | - John M Stulak
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Niv Ad
- Inova Fairfax Hospital, Cardiac Surgery Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Allison Siegel
- Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, Orlando, Florida
| | - Alessandro Giamberti
- Pediatric and Adult Congenital Heart Surgery, IRCSS Policlinico San Donato, San Donato M.se (MI), Italy
| | - Louise Harris
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto Congenital Cardiac Centre for Adults, Toronto, Ontario, Canada
| | - Carl L Backer
- Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sabrina Tsao
- Division of Cardiology and the Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nihal Weerasena
- Division of Cardiothoracic Surgery, The General Infirmary, Leeds, United Kingdom
| | - Barbara J Deal
- Division of Cardiology and the Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Khairy P, Dore A, Talajic M, Dubuc M, Poirier N, Roy D, Mercier LA. Arrhythmias in adult congenital heart disease. Expert Rev Cardiovasc Ther 2014; 4:83-95. [PMID: 16375631 DOI: 10.1586/14779072.4.1.83] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent advances in pediatric cardiology and cardiac surgery have allowed a rapidly expanding population of patients with congenital heart disease to thrive well into their adult years. Often after prolonged uneventful clinical courses as children and adolescents, arrhythmias may surface later in life. These arrhythmias are a major source of morbidity. In addition, sudden death is the leading cause of mortality in adult patients with congenital heart disease. This review highlights the various types of brady- and tachyarrhythmias encountered in the more common forms of adult congenital heart disease and explores prognostic implications and therapeutic options.
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Affiliation(s)
- Paul Khairy
- Electrophysiology and Adult Congenital Heart Disease, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.
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33
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Le Gloan L, Guerin P, Mercier LA, Abbey S, Dore A, Marcotte F, Ibrahim R, Poirier NC, Khairy P. Clinical assessment of arrhythmias in tetralogy of Fallot. Expert Rev Cardiovasc Ther 2014; 8:189-97. [DOI: 10.1586/erc.09.156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Koyak Z, de Groot JR, Mulder BJM. Interventional and surgical treatment of cardiac arrhythmias in adults with congenital heart disease. Expert Rev Cardiovasc Ther 2014; 8:1753-66. [DOI: 10.1586/erc.10.152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hirono K, Sekine M, Shiba N, Hayashi S, Nakaoka H, Ibuki K, Saito K, Watanabe K, Ozawa S, Higuma T, Yoshimura N, Kitajima I, Ichida F. N-terminal pro-Brain Natriuretic Peptide as a Predictor of Reoperation in Children With Surgically Corrected Tetralogy of Fallot. Circ J 2014; 78:693-700. [DOI: 10.1253/circj.cj-13-1048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Michikazu Sekine
- Department of Welfare Promotion and Epidemiology, Graduate School of Medicine, University of Toyama
| | - Noriko Shiba
- Department of Clinical Pharmacy, Graduate School of Medicine, University of Toyama
| | - Shirou Hayashi
- Department of Clinical Pharmacy, Graduate School of Medicine, University of Toyama
| | - Hideyuki Nakaoka
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Keijiro Ibuki
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Kazuyoshi Saito
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Kazuhiro Watanabe
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Sayaka Ozawa
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
| | - Tomonori Higuma
- First Department of Surgery, Graduate School of Medicine, University of Toyama
| | - Naoki Yoshimura
- First Department of Surgery, Graduate School of Medicine, University of Toyama
| | - Isao Kitajima
- Department of Clinical Pharmacy, Graduate School of Medicine, University of Toyama
| | - Fukiko Ichida
- Department of Pediatrics, Graduate School of Medicine, University of Toyama
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Bernard Y, Morel M, Descotes-Genon V, Jehl J, Meneveau N, Schiele F. Value of Speckle Tracking for the Assessment of Right Ventricular Function in Patients Operated on for Tetralogy of Fallot. Comparison with Magnetic Resonance Imaging. Echocardiography 2013; 31:474-82. [DOI: 10.1111/echo.12386] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yvette Bernard
- Cardiology Department; EA3920, University Hospital Jean Minjoz; Besançon France
| | - Mathilde Morel
- Cardiology Department; EA3920, University Hospital Jean Minjoz; Besançon France
| | | | - Jerome Jehl
- Radiology Department; University Hospital Jean Minjoz; Besançon France
| | - Nicolas Meneveau
- Cardiology Department; EA3920, University Hospital Jean Minjoz; Besançon France
| | - Francois Schiele
- Cardiology Department; EA3920, University Hospital Jean Minjoz; Besançon France
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Bonello B, Kempny A, Uebing A, Li W, Kilner PJ, Diller GP, Pennell DJ, Shore DF, Ernst S, Gatzoulis MA, Babu-Narayan SV. Right atrial area and right ventricular outflow tract akinetic length predict sustained tachyarrhythmia in repaired tetralogy of Fallot. Int J Cardiol 2013; 168:3280-6. [PMID: 23643427 PMCID: PMC3819622 DOI: 10.1016/j.ijcard.2013.04.048] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/06/2013] [Indexed: 11/24/2022]
Abstract
Aims Repaired tetralogy of Fallot (rtoF) patients are at risk of atrial or ventricular tachyarrhythmia and sudden cardiac death. Risk stratification for arrhythmia remains difficult. We investigated whether cardiac anatomy and function predict arrhythmia. Methods One-hundred-and-fifty-four adults with rtoF, median age 30.8 (21.9–40.2) years, were studied with a standardised protocol including cardiovascular magnetic resonance (CMR) and prospectively followed up over median 5.6 (4.6–7.0) years for the pre-specified endpoints of new-onset atrial or ventricular tachyarrhythmia (sustained ventricular tachycardia/ventricular fibrillation). Results Atrial tachyarrhythmia (n = 11) was predicted by maximal right atrial area indexed to body surface area (RAAi) on four-chamber cine-CMR (Hazard ratio 1.17, 95% Confidence Interval 1.07–1.28 per cm2/m2; p = 0.0005, survival receiver operating curve; ROC analysis, area under curve; AUC 0.74 [0.66–0.81]; cut-off value 16 cm2/m2). Atrial arrhythmia-free survival was reduced in patients with RAAi ≥ 16 cm2/m2 (logrank p = 0.0001). Right ventricular (RV) restrictive physiology on echocardiography (n = 38) related to higher RAAi (p = 0.02) and had similar RV dilatation compared with remaining patients. Ventricular arrhythmia (n = 9) was predicted by CMR RV outflow tract (RVOT) akinetic area length (Hazard ratio 1.05, 95% Confidence Interval 1.01–1.09 per mm; p = 0.003, survival ROC analysis, AUC 0.77 [0.83–0.61]; cut-off value 30 mm) and decreased RV ejection fraction (Hazard ratio 0.93, 95% Confidence Interval 0.87–0.99 per %; p = 0.03). Ventricular arrhythmia-free survival was reduced in patients with RVOT akinetic region length > 30 mm (logrank p = 0.02). Conclusion RAAi predicts atrial arrhythmia and RVOT akinetic region length predicts ventricular arrhythmia in late follow-up of rtoF. These are simple, feasible measurements for inclusion in serial surveillance and risk stratification of rtoF patients.
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Affiliation(s)
- Beatrice Bonello
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, United Kingdom
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Ito H, Ota N, Murata M, Tosaka Y, Ide Y, Tachi M, Sugimoto A, Sakamoto K. Technical modification enabling pulmonary valve-sparing repair of a severely hypoplastic pulmonary annulus in patients with tetralogy of Fallot. Interact Cardiovasc Thorac Surg 2013; 16:802-7. [PMID: 23475118 DOI: 10.1093/icvts/ivt095] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although pulmonary valve-sparing repair is preferable for patients with tetralogy of Fallot, the repair of very small pulmonary valves is challenging. The present study evaluates our modification for preserving severely hypoplastic pulmonary valves in patients with tetralogy of Fallot. METHODS Sixty-eight consecutive patients who underwent complete repair of a tetralogy of Fallot between 2005 and 2011 were retrospectively reviewed. Patients with pulmonary atresia, absence of a pulmonary valve, atrioventricular septal defect and/or subarterial ventricular septal defect were excluded. There were 19 (28%) patients with a severely hypoplastic pulmonary annulus determined by preoperative echocardiography (z-score <-4). For these patients, we collected echocardiographic data and information about their postoperative course. RESULTS Valve preserving was successful in 11 of 19 (58%) of the z < -4 group, compared with 48 of 49 (98%) of the z > -4 group. In the z < -4 valve-sparing subgroup (n = 11), the preoperative pulmonary valve diameter z-score was -4.9 (range -6.3 to -4.3), and an approach involving ventriculotomy with no transannular patch was employed at a mean age of 6.9 (range 2.2-16.1) months. In this subgroup, residual right ventricular outflow tract velocity was 2.4 ± 0.6 m/s at discharge from the hospital. During a mean follow-up of 2.6 ± 2.4 years, no reintervention was necessary. Late right ventricular outflow tract velocity was 2.2 ± 0.6 m/s, and there was no severe pulmonary regurgitation. The pulmonary valve annulus grew in relation to the patient's body surface area (z = -0.51, range -4.2-0.24) without any aneurysmal changes in the right ventricular outflow tract. CONCLUSIONS Although our modification of valve-sparing repair for severely hypoplastic pulmonary valves in patients with tetralogy of Fallot could not be applied in all patients, this strategy enabled acceptable growth of the valve annulus, with only mild stenosis during the early to mid-term follow-up. This modification seems to be an option, even for a very small pulmonary valve.
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Affiliation(s)
- Hiroki Ito
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
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Chaowalit N, Durongpisitkul K, Krittayaphong R, Komoltri C, Jakrapanichakul D, Phrudprisan S. Echocardiography as a Simple Initial Tool to Assess Right Ventricular Dimensions in Patients with Repaired Tetralogy of Fallot before Undergoing Pulmonary Valve Replacement: Comparison with Cardiovascular Magnetic Resonance Imaging. Echocardiography 2012; 29:1239-46. [DOI: 10.1111/j.1540-8175.2012.01766.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR. Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair. Eur J Cardiothorac Surg 2012; 42:e1-8. [DOI: 10.1093/ejcts/ezs219] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Groot NMS, Lukac P, Schalij MJ, Makowski K, Szili-Torok T, Jordaens L, Nielsen JC, Jensen HK, Gerdes JC, Delacretaz E. Long-term outcome of ablative therapy of post-operative atrial tachyarrhythmias in patients with tetralogy of Fallot: a European multi-centre study. Europace 2011; 14:522-7. [DOI: 10.1093/europace/eur313] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Yap SC, Harris L, Chauhan VS, Oechslin EN, Silversides CK. Identifying high risk in adults with congenital heart disease and atrial arrhythmias. Am J Cardiol 2011; 108:723-8. [PMID: 21684512 DOI: 10.1016/j.amjcard.2011.04.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/10/2011] [Accepted: 04/10/2011] [Indexed: 10/18/2022]
Abstract
Atrial arrhythmias are associated with an increased mortality risk in adults with congenital heart disease (CHD). However, little is known about risk stratification in the specific group of adult patients with CHD and atrial arrhythmias. We sought to identify predictors of mortality in adult with CHD and atrial arrhythmias and to establish a risk score. The study involved 378 adult patients with CHD (mean age 39 ± 13 years) and atrial arrhythmias who had serial follow-up in a tertiary referral center from 1999 through 2009. During a median follow-up of 5.2 years, there were 40 deaths (11%). Overall mortality rate was 2.0% per patient-year. Common modes of death included heart failure-related death (35%), sudden cardiac death (20%), and perioperative death (18%). Independent predictors of mortality were poor functional class (hazard ratio 3.69, 95% confidence interval [CI] 1.69 to 8.03, p = 0.001), single-ventricle physiology (hazard ratio 3.33, 95% CI 1.51 to 7.35, p = 0.003), pulmonary hypertension (hazard ratio 2.96, 95% CI 1.41 to 6.19, p = 0.004), and valvular heart disease (hazard ratio 2.73, 95% CI 1.33 to 5.59, p = 0.006). A risk score was constructed using these predictors in which patients were assigned 1 point for the presence of each risk factor. Mortality rates in the low-risk (no risk factor), moderate-risk (1 risk factor), and high-risk (>1 risk factor) groups were 0.5%, 1.9%, and 6.5% per patient-year, respectively (log-rank p <0.001). In conclusion, in adult with CHD and atrial arrhythmias specific clinical variables identify patients at high risk for death. Importantly, the absence of any of these risk factors is associated with an excellent survival despite the presence of atrial arrhythmias.
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Perry J, Lanzberg M, Franklin W, Webb G, Chang AC. Cardiac Intensive Care of the Adult With Congenital Heart Disease: Basic Principles in the Management of Common Problems. World J Pediatr Congenit Heart Surg 2011; 2:430-44. [DOI: 10.1177/2150135111407936] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although there has been an intense interest in the care of the adult with congenital heart disease (ACHD), these guidelines are usually not focused on the concepts of immediate postoperative care. The 2 most common perioperative complications are heart failure and atrial dysrhythmias. The broad etiological categories for ACHD and heart failure include primary pump failure (systolic dysfunction) and hypertrophy (diastolic dysfunction) of the right, left, or single ventricle. Some conditions with a pressure-loaded systemic right ventricle as well as patients with a functionally single ventricle may be particularly prone to develop heart failure; in others, right heart failure may occur in patients with Ebstein anomaly or with tetralogy of Fallot after corrective repair but with varying degrees of pulmonary insufficiency, and left heart failure can be a result of mitral or aortic insufficiency. The management of postoperative atrial tachycardia in the ACHD patient actually begins prior to surgery. Assessment of arrhythmia history, complete determination of risk, inducibility and arrhythmia substrate, preoperative planning of pacing sites, and optimal pacing strategies all assist to bring about optimal postoperative outcomes. Ideal perioperative care of the ACHD involves a multidisciplinary team of pediatric and adult cardiologists, pediatric and adult intensivists, cardiac surgeons, and nursing staff along with a myriad of adult subspecialists such as pulmonology, nephrology, endocrinology, and others including psychiatry.
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Affiliation(s)
- James Perry
- Rady Children's Hospital and UCSD School of Medicine, San Diego, CA, USA
| | | | | | - Gary Webb
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Meyer C, Martinek M, Winter S, Nesser HJ, Pürerfellner H. [Arrhythmias in patients with surgically corrected tetralogy of Fallot]. Herzschrittmacherther Elektrophysiol 2011; 21:189-95. [PMID: 20734055 DOI: 10.1007/s00399-010-0103-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The population of adults with surgically corrected tetralogy of Fallot (TOF) is increasing. Atrial and ventricular arrhythmias are prevalent, and therapeutical approaches including implantable cardioverter-defibrillators and radiofrequency catheter ablation need to be considered carefully for the prevention of hemodynamic deterioration and sudden cardiac death. Complex anatomy, myocardial hypertrophy, and broad channels of slow conduction may in part explain some challenges regarding risk stratification, and identification/modification of the arrhythmogenic substrate in these patients. The aim of this brief review is 2-fold: (1.) To present insights into characteristics of typical TOF related arrhythmias and (2.) to reflect therapeutical concepts targeting tachyarrhythmias in these patients by focusing on catheter ablation.
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Affiliation(s)
- C Meyer
- Abteilung für Innere Medizin II/Kardiologie, Krankenhaus der Elisabethinen, Linz, Osterreich.
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Taquiarritmias postoperatorias en la cirugía cardíaca pediátrica. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon FP, Kay J, Valente AM, Earing MG, Lui G, Gersony DR, Cook S, Ting JG, Nickolaus MJ, Webb G, Landzberg MJ, Broberg CS. Arrhythmia Burden in Adults With Surgically Repaired Tetralogy of Fallot. Circulation 2010; 122:868-75. [DOI: 10.1161/circulationaha.109.928481] [Citation(s) in RCA: 382] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background—
The arrhythmia burden in tetralogy of Fallot, types of arrhythmias encountered, and risk profile may change as the population ages.
Methods and Results—
The Alliance for Adult Research in Congenital Cardiology (AARCC) conducted a multicenter cross-sectional study to quantify the arrhythmia burden in tetralogy of Fallot, to characterize age-related trends, and to identify associated factors. A total of 556 patients, 54.0% female, 36.8±12.0 years of age were recruited from 11 centers. Overall, 43.3% had a sustained arrhythmia or arrhythmia intervention. Prevalence of atrial tachyarrhythmias was 20.1%. Factors associated with intraatrial reentrant tachycardia in multivariable analyses were right atrial enlargement (odds ratio [OR], 6.2; 95% confidence interval [CI], 2.8 to 13.6), hypertension (OR, 2.3; 95% CI, 1.1 to 4.6), and number of cardiac surgeries (OR, 1.4; 95% CI, 1.2 to 1.6). Older age (OR, 1.09 per year; 95% CI, 1.05 to 1.12), lower left ventricular ejection fraction (OR, 0.93 per unit; 95% CI, 0.89 to 0.96), left atrial dilation (OR, 3.2; 95% CI, 1.5 to 6.8), and number of cardiac surgeries (OR, 1.5; 95% CI, 1.2 to 1.9) were jointly associated with atrial fibrillation. Ventricular arrhythmias were prevalent in 14.6% and jointly associated with number of cardiac surgeries (OR, 1.3; 95% CI, 1.1 to 1.6), QRS duration (OR, 1.02 per 1 ms; 95% CI, 1.01 to 1.03), and left ventricular diastolic dysfunction (OR, 3.3; 95% CI, 1.5 to 7.1). Prevalence of atrial fibrillation and ventricular arrhythmias markedly increased after 45 years of age.
Conclusions—
The arrhythmia burden in adults with tetralogy of Fallot is considerable, with various subtypes characterized by different profiles. Atrial fibrillation and ventricular arrhythmias appear to be influenced more by left- than right-sided heart disease.
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Affiliation(s)
- Paul Khairy
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Jamil Aboulhosn
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Michelle Z. Gurvitz
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Alexander R. Opotowsky
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - François-Pierre Mongeon
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Joseph Kay
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Anne Marie Valente
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Michael G. Earing
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - George Lui
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Deborah R. Gersony
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Stephen Cook
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Jennifer Grando Ting
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Michelle J. Nickolaus
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Gary Webb
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Michael J. Landzberg
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
| | - Craig S. Broberg
- From the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada (P.K., F.P.M.); University of California, Los Angeles (J.A.); University of Washington, Seattle (M.Z.G.); Boston Adult Congenital Heart Service, Children’s Hospital Boston, Boston, Mass (P.K., A.R.O., A.M.V., M.J.L.); University of Colorado, Denver (J.K.); Medical College of Wisconsin, Milwaukee (M.G.E.); Columbia University Medical Center, New York, NY (G.L., D.R.G.); Ohio State University, Columbus (S.C.); Hershey
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Huh J. Practical stepwise approach to rhythm disturbances in congenital heart diseases. KOREAN JOURNAL OF PEDIATRICS 2010; 53:680-7. [PMID: 21189938 PMCID: PMC2994137 DOI: 10.3345/kjp.2010.53.6.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 05/19/2010] [Indexed: 11/30/2022]
Abstract
Patients with congenital heart diseases (CHD) are confronted with early- and late-onset complications, such as conduction disorders, arrhythmias, myocardial dysfunction, altered coronary flow, and ischemia, throughout their lifetime despite successful hemodynamic and/or anatomical correction. Rhythm disturbance is a well-known and increasingly frequent cause of morbidity and mortality in patients with CHD. Predisposing factors to rhythm disturbances include underlying cardiac defects, hemodynamic changes as part of the natural history, surgical repair and related scarring, and residual hemodynamic abnormalities. Acquired factors such as aging, hypertension, diabetes, obesity, and others may also contribute to arrhythmogenesis in CHD. The first step in evaluating arrhythmias in CHD is to understand the complex anatomy and to find predisposing factors and hemodynamic abnormalities. A practical stepwise approach can lead to diagnosis and prompt appropriate interventions. Electrophysiological assessment and management should be done with integrated care of the underlying heart defects and hemodynamic abnormalities. Catheter ablation and arrhythmia surgery have been increasingly applied, showing increasing success rates with technological advancement despite complicated arrhythmia circuits in complex anatomy and the difficulty of access. Correction of residual hemodynamic abnormalities may be critical in the treatment of arrhythmia in patients with CHD.
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Affiliation(s)
- June Huh
- Department of Pediatrics, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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50
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Kwon DS, Marcus GM. Atrial Flutter Late After Remote Tetralogy of Fallot Repair. Card Electrophysiol Clin 2010; 2:309-311. [PMID: 28770771 DOI: 10.1016/j.ccep.2010.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This case illustrates an atypical presentation of typical atrial flutter, demonstrating the importance of always considering cavo-tricuspid isthmus dependent atrial flutter as the potential culprit.
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Affiliation(s)
- David S Kwon
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, 500 Parnassus Avenue, MU 434, San Francisco, CA 94143, USA
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