Clinical Characteristics of Patients with Tetralogy of Fallot who Underwent an Invasive Procedure for Arrhythmias

Authors

  • Barbara Adelmann de Lima Pontifícia Universidade Católica do Rio Grande do Sul - Escola de Medicina – Porto Alegre (RS), Brazil. https://orcid.org/0000-0002-3531-4128
  • Antonio Carlos Gallo da Silva Universidade Federal de Ciências da Saúde de Porto Alegre – Porto Alegre (RS), Brazil.
  • Marco Aurélio Lumertz Saffi Universidade Federal de Ciências da Saúde de Porto Alegre – Porto Alegre (RS), Brazil.
  • Clóvis Fröemming Junior Instituto de Cardiologia do Rio Grande do Sul – Porto Alegre (RS), Brazil.
  • Gabriela Castilhos Instituto de Cardiologia do Rio Grande do Sul – Porto Alegre (RS), Brazil. https://orcid.org/0000-0001-6738-6065
  • Marcelo Lapa Kruse Instituto de Cardiologia do Rio Grande do Sul – Porto Alegre (RS), Brazil.
  • Gustavo Glotz de Lima Universidade Federal de Ciências da Saúde de Porto Alegre – Porto Alegre (RS), Brazil. / Instituto de Cardiologia do Rio Grande do Sul – Porto Alegre (RS), Brazil.
  • Tiago Luiz Luz Leiria Instituto de Cardiologia do Rio Grande do Sul – Porto Alegre (RS), Brazil.

Keywords:

Tetralogy of Fallot, Cardiac Electrophysiology, Tetralogy of Fallot, Arrhythmias, Cardiac

Abstract

Introduction: Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that has an incidence of sudden cardiac death of 0.2% per year, being arrhythmias the main cause of its occurrence. Objective: To compare characteristics of TOF patients referred for electrophysiological study (EPS) against those that were not (No-EPS). Method: Retrospective cohort with 215 patients (57.2% men; age = 29 ± 4) with corrected TOF (median of three years, ranging from 0.33 to 51) that underwent EPS between 2009-2020. The primary outcome was composed of death, implantable cardiac defibrillator (ICD) requirement and hospitalization. Results: Pre-syncope (EPS = 4.7%, No-EPS = 0%; p = 0.004), syncope (EPS = 7.1%, No-EPS = 1.7%; p = 0.056) and palpitations (EPS = 31%, No-EPS = 5.8%; p < 0.001) were symptoms that justified electrophysiological investigation. ICD was implanted in 24% of EPS and 0.6% of No-EPS (p=0.001). Twenty-six percent of the EPS group presented non-sustained ventricular tachycardia, while 0% in No-EPS (p = 0.012). The EPS group had more atrial fibrillation or atrial Flutter (35.7% vs. 6.9%; p < 0.001). The EPS patients had a wider QRS duration than the no-EPS group (171.12 ± 29.52 ms vs. 147 ± 29.77 ms; p < 0.001). Also, 26.2% of EPS performed ablation to correct macroreentrant atrial tachycardias. The incidence of primary outcome (death + ICD requirement + hospitalization) was higher in patients in the EPS group compared to the No-EPS group (p = 0.001). However, the total of seven deaths occurred during the clinical follow-up, but without differences between the groups (EPS = 4.7% vs. No-EPS = 2.8%; p = 0.480). Conclusion: EPS group had a profile of greater risk, more complex heart disease, and a greater occurrence of the primary outcome when compared to the No-EPS group.

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References

Villafañe J, Feinstein JA, J Jenkins KJ, Vincent RN, P Walsh EP, Dubin AM, et al. Hot topics in tetralogy of Fallot. J Am Coll Cardiol. 2013;62(23):2155-66. https://doi.org/10.1016/j.jacc.2013.07.100

Apitz C, Webb GD, Redington AN. Tetralogy of Fallot. Lancet. 2009;374(9699):1462-71. https://doi.org/10.1016/s0140-6736(09)60657-7

Bertranou EG, Blackstone EH, Hazelrig JB, Turner ME, Kirklin JW. Life expectancy without surgery in tetralogy of Fallot. Am J Cardiol.1978;42(3):458-66. https://doi.org/10.1016/0002-9149(78)90941-4

Papagiannis JK. Postoperative arrhythmias in tetralogy of Fallot. Hell J Cardiol [Internet]. 2005 [cited on March 21, 2021];46(6):402-7. Available from: https://www.hellenicjcardiol.org/archive/full_text/2005/6/2005_6_402.pdf

Van Doorn C. The unnatural history of tetralogy of Fallot: surgical repair is not as definitive as previously thought. Heart. 2002;88(5):447-8. http://dx.doi.org/10.1136/heart.88.5.447

Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation. 2003;108(15):1871-909. https://doi.org/10.1161/01.cir.0000091380.04100.84

Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000;356(9234):975-81. https://doi.org/10.1016/s0140-6736(00)02714-8

Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon F-P, Kay J, et al. Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation. 2010;122(9):868-75. https://doi.org/10.1161/circulationaha.109.928481

Oliveira GS, Oliveira FS, Osório APS, Medeiros AK, Sant’anna JRM, Leiria TLL. Late outcome and predictors of adverse events related to the implantation of a permanent pacemaker in patients with isolated congenital atrioventricular block. Pediatr Cardiol. 2021;37(7):1319-27. https://doi.org/10.1007/s00246-016-1437-0

Maury P, Sacher F, Rollin A, Mondoly P, Duparc A, Zeppenfeld K, et al. Ventricular arrhythmias and sudden death in tetralogy of Fallot. Arch Cardiovasc Dis. 2017;110(5):354-362. https://doi.org/10.1016/j.acvd.2016.12.006

Khairy P, Harris L, Landzberg MJ, Viswanathan S, Barlow A, Gatzoulis MA, et al. Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation. 2008;117(3):363-70. https://doi.org/10.1161/circulationaha.107.726372

Page RL, José JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2016;67(13):e27-e115. https://doi.org/10.1016/j.jacc.2015.08.856

Khairy P. Arrhythmias in adults with congenital heart disease: what the practicing cardiologist needs to know. Can J Cardiol. 2019;35(12):1698-707. https://doi.org/10.1016/j.cjca.2019.07.009

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Published

2021-12-17

How to Cite

Adelmann de Lima, B., Gallo da Silva, A. C., Saffi, M. A. L., Fröemming Junior, C., Castilhos, G. ., Lapa Kruse , M., Glotz de Lima, G. ., & Luz Leiria, T. L. (2021). Clinical Characteristics of Patients with Tetralogy of Fallot who Underwent an Invasive Procedure for Arrhythmias. JOURNAL OF CARDIAC ARRHYTHMIAS, 34(3), 91–99. Retrieved from https://jca.emnuvens.com.br/jca/article/view/3452

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Section

Clinical Arrythmia

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