title: The impact of exercise on ventricular arrhythmias in adults with tetralogy of Fallot.
abstract: BACKGROUND
  Sudden death of presumed arrhythmic etiology is the leading cause of mortality in adults with tetralogy of Fallot.
  
  
  OBJECTIVE
  To assess the impact of exercise on ventricular arrhythmias in adults with tetralogy of Fallot.
  
  
  METHODS
  Adults with repaired tetralogy of Fallot were randomized in a 2:1 ratio to an open-label trial of standard care versus 12weeks of supervised combined aerobic/resistance training with continuous Holter monitoring. Proportion of premature ventricular complexes (PVC) and runs of non-sustained ventricular tachycardia (NSVT) were assessed by mixed and Poisson regression models with generalized estimating equations for repeated measures.
  
  
  RESULTS
  A total of 152 Holters were performed in 17 patients, median age 35 (interquartile range [IQR] 28, 42) years, 65% male, 13 of whom were randomized to exercise training. Baseline characteristics were similar between groups. Exercise training resulted in significant increases in peak oxygen uptake (11±19%, p=0.028), metabolic equivalents (11±18%, p=0.027), and exercise duration (8±10%, p=0.009) compared to no changes in controls. Frequent (≥30 per hour) PVCs were present in 46% of patients, couplets in 62%, and 3 to 7 beat runs of NSVT in 31%. The median proportion of PVCs was 1.93‰ (IQR 0.41, 5.89) at baseline and 1.45‰ (IQR 0.08, 2.76) during the initial exercise session (p=0.722), and remained stable over time (ß coefficient=-0.031, p=0.408). Runs of NSVT decreased significantly over time (ß coefficient=-0.032, p=0.018).
  
  
  CONCLUSIONS
  In adults with repaired tetralogy of Fallot, exercise training is safe, improves exercise capacity, and appears to confer a beneficial effect on ventricular arrhythmias.
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada; Department of Cardiology, Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Universidad Complutense, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ávila
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Marcotte
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Dore
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Lise-Andrée
authors.initials: LA
authors.lastname: Mercier
authors.affiliation: Montreal Health Innovations Coordinating Center, Université de Montréal, Montreal, Canada.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Shohoudi
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: François-Pierre
authors.initials: FP
authors.lastname: Mongeon
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Blandine
authors.initials: B
authors.lastname: Mondésert
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Proietti
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Asgar
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Poirier
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada; Montreal Health Innovations Coordinating Center, Université de Montréal, Montreal, Canada. Electronic address: paul.khairy@umontreal.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
mesh_terms: D000328:Adult; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000639:trends; D055070:Resistance Training / Q000379:methods* / Q000639:trends; D017180:Tachycardia, Ventricular / Q000503:physiopathology* / Q000534:rehabilitation*; D013771:Tetralogy of Fallot / Q000503:physiopathology* / Q000534:rehabilitation*
keywords: Exercise; Tetralogy of Fallot; Training; Ventricular tachycardia