Late sudden deaths after repair of tetralogy of Fallot. Electrocardiographic findings associated with survival.
Of 141 hospital survivors after intracardiac repair of tetralogy of Fallot, eight died suddenly 6-23 years later. Compared with the other 133 patients, these eight were older at operation, with higher post-repair systolic right ventricular pressure and more often complete atrioventricular block; ventricular arrhythmia was diagnosed before death in three cases. In follow-up totalling 2255 patient years, the linearized rate of sudden death was 0.35%/year. The instantaneous risk of sudden death showed continuous increase with the length of follow-up. Of 80 survivors electrocardiographically evaluated 13-26 (median 20) years postoperatively, none had complete block, but 79 had complete right bundle branch block, including seven with left anterior hemiblock. Ventricular extrasystoles were recorded in 1% at rest, in 34% during exercise and in 83% during 24-hour ambulatory monitoring, with Lown Grade > or = II in 27%. Old age and possibly presence of fibrosis and/or fibroelastosis in right ventricular outflow Lown Grade. A patient with Lown grade III died suddenly 2 years after our follow-up. Old age at repair thus was associated with increased risk of late sudden death and with frequent ventricular arrhythmia in long-term survivors.
Jonsson
H
H
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Ivert
T
T
Brodin
L A
LA
Jonasson
R
R
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002037:Bundle-Branch Block / Q000209:etiology; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D004719:Endomyocardial Fibrosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000601:surgery*; D018754:Ventricular Dysfunction / Q000209:etiology; D016278:Ventricular Function, Right; D018879:Ventricular Premature Complexes / Q000209:etiology; D017725:Ventricular Pressure