title: A prospective 5-year study of the frequency of arrhythmias during serial exercise testing and clinical follow-up after Melody valve implant.
abstract: Although percutaneous Melody valve implant has become an accepted alternative to surgical pulmonary valve replacement in patients with congenital heart disease, the benefit regarding frequency and severity of arrhythmias remains undefined.
  
  
  
  The purpose of this study was to evaluate the impact of Melody valve implant on the type and frequency of arrhythmias during cardiopulmonary exercise testing (CPET) and subsequent clinical outcome.
  
  
  
  As part of the phase I Melody valve clinical trial, 136 patients with congenital heart disease underwent prospective serial evaluation including CPET before implant, 6 months after implant, and annually thereafter for 5 years. Arrhythmias were defined as premature ventricular complexes (PVCs) and supraventricular or ventricular tachycardia (VT).
  
  
  
  Before Melody implant, PVCs occurred in 55 patients (40%) and nonsustained ventricular tachycardia (NSVT) in 1 patient during CPET. Median age at valve implantation was 19.0 years (range 7-53 years). During median follow-up of 4.9 years (range 0.8-7.3 years), there was no significant change in the proportion of patients with PVCs during CPET at any follow-up interval (40%-45%). However, postimplant, NSVT occurred in 18 patients, including 8 during CPET. Diagnoses in the patients with NSVT were tetralogy of Fallot (11), transposition (2), and post-Ross procedure (5). Improved hemodynamic status was not associated with resolution or prevention of arrhythmias.
  
  
  
  Despite improvement in hemodynamics, Melody valve implant was not associated with resolution or prevention of arrhythmias during CPET. PVCs or VT may be related to pathologic hypertrophy, fibrosis, dilation, or possible mechanical effects of the Melody device.
authors.affiliation: Children's Hospital Los Angeles, University of Southern California, Los Angeles, California.
authors.forename: Bryant
authors.initials: B
authors.lastname: Priromprintr
authors.affiliation: Children's Hospital Los Angeles, University of Southern California, Los Angeles, California.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silka
authors.affiliation: Children's Hospital of Boston, Boston, Massachusetts.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rhodes
authors.affiliation: Children's Hospital of Orange County, University of California Irvine, Orange, California. Electronic address: abatra@uci.edu.
authors.forename: Anjan S
authors.initials: AS
authors.lastname: Batra
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D002648:Child; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
keywords: Congenital heart disease; Exercise testing; Tetralogy of Fallot; Valve replacement; Ventricular tachycardia