title: Ventricular arrhythmia risk stratification in patients with tetralogy of Fallot at the time of pulmonary valve replacement.
abstract: BACKGROUND
  Most patients with repaired tetralogy of Fallot require pulmonary valve replacement (PVR), but the evaluation for and management of ventricular arrhythmia remain unclear. This study is aimed at clarifying the optimal approach to this potentially life-threatening issue at the time of PVR.
  
  
  RESULTS
  A retrospective analysis was performed on 205 patients with repaired tetralogy of Fallot undergoing PVR at our institution between 1988 and 2010. Median age was 32.9 (range, 25.6) years. Previous ventricular tachycardia occurred in 16 patients (8%) and 37 (16%) had left ventricular dysfunction, defined as left ventricular ejection fraction <50%. Surgical right ventricular outflow tract cryoablation was performed in 22 patients (10.7%). The primary outcome was a combined event including ventricular tachycardia, out-of-hospital cardiac arrest, appropriate implantable cardioverter defibrillator therapy, and sudden cardiac death. Freedom from the combined event at 5, 10, and 15 years was 95%, 90%, and 79%, respectively. In the first year after PVR, 2 events occurred. Conversely, in the 22 patients who underwent surgical cryoablation, a single event occurred 7 years after PVR. A history of ventricular tachycardia and left ventricular dysfunction was associated with higher risk for the combined event (hazard ratio, 4.7; P=0.004 and hazard ratio, 0.8; P=0.02, respectively).
  
  
  CONCLUSIONS
  Patients with repaired tetralogy of Fallot undergoing PVR with history of ventricular tachycardia or left ventricular dysfunction appear to be associated with a higher risk of arrhythmic events after operation. Events in the first year after PVR are rare, and in select high-risk patients, surgical cryoablation does not seem to increase arrhythmic events and may be protective.
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Anna
authors.initials: A
authors.lastname: Sabate Rotes
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Carole A
authors.initials: CA
authors.lastname: Warnes
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Naser M
authors.initials: NM
authors.lastname: Ammash
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Sabrina D
authors.initials: SD
authors.lastname: Phillips
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.).
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.affiliation: From the Division of Cardiovascular Disease (A.S.R., H.M.C., C.A.W., N.M.A., S.D.P., S.J.A., C.J.M.), Division of Cardiovascular Surgery (J.A.D., H.V.S., H.M.B.), and Division of Biomedical Statistics and Informatics (D.O.H.), Mayo Clinic, Rochester, MN; and Pediatric Cardiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.S.R.). mcleod.christopher@mayo.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McLeod
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left; D055815:Young Adult
keywords: arrhythmias, cardiac; cryosurgery; heart valve prosthesis implantation; pulmonary valve; tetralogy of Fallot