Efficacy of hemodynamic-based management of tachyarrhythmia after repair of tetralogy of Fallot.
BACKGROUND
Supraventricular and ventricular tachyarrhythmias (SVT, VT) are major concerns after repair of tetralogy of Fallot (TOF). This study evaluated the impact of comprehensive treatment, including hemodynamic interventions such as surgery, catheter-based intervention and pacemaker implantation (PMI), on tachyarrhythmia in repaired TOF patients.


RESULTS
Of 66 repaired TOF patients with tachyarrhythmia (age at onset, 23±11 years), 29 patients had sustained SVT, 21 had sustained or non-sustained VT, and 16 had both (SVT+VT). Successful treatment with catheter-directed ablation and/or anti-arrhythmic drugs (AADs) alone was achieved in 31 (69%) and partially achieved in 6 (13%) of 45 patients. Surgery, catheter-based intervention, and/or PMI were performed in 21 (32%) of 66 patients and resulted in complete control of the arrhythmia in 8 (38%) and partial control in 7 (33%) of these 21 patients, 20 (95%) of whom were receiving AADs. Patients with successfully controlled tachyarrhythmia in response to catheter ablation and/or AADs without hemodynamic intervention had a significantly higher probability of absence of sinus node dysfunction (odds ratio [OR], 23.2; 95% confidence interval [CI], 1.8-845.2; P=0.02) and lone intra-atrial reentrant tachycardia (OR, 12.4; 95% CI: 1.3-278.7; P=0.03).


CONCLUSIONS
Hemodynamic interventions resulted in an improvement in outcomes in repaired TOF patients with tachyarrhythmia. To effectively manage intractable tachyarrhythmia with hemodynamic abnormalities, it is essential to understand hemodynamics and consider hemodynamic intervention.
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan. ayamiya@hsp.ncvc.go.jp
Aya
A
Miyazaki
Heima
H
Sakaguchi
Hideo
H
Ohuchi
Michio
M
Matsuoka
Akiko
A
Komori
Tetsuya
T
Yamamoto
Kenji
K
Yasuda
Kazuhiro
K
Satomi
Takaya
T
Hoashi
Shiro
S
Kamakura
Osamu
O
Yamada
D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D000889:Anti-Arrhythmia Agents