Percutaneous Pulmonary Valve Implantation-Associated Ventricular Tachycardia in Congenital Heart Disease.
BACKGROUND
Percutaneous pulmonary valve implantation (PPVI) is utilized for dysfunctional right ventricular outflow tracts (RVOT) to relieve obstruction, regurgitation, and RV dysfunction. PPVI has not been reported to induce arrhythmias. This study is the first to report the incidence of ventricular tachycardia (VT) after PPVI.


METHODS
This was a retrospective study of all patients who had PPVI at a single institution. All patients were admitted after PPVI for overnight telemetry monitoring. Patients with no prior history of VT and newly detected VT within 24 hours post-PPVI were considered to have VT related to PPVI.


RESULTS
In total, 79 patients had PPVI (age 17 ± 9 years, 66% tetralogy of Fallot/pulmonary atresia). PPVI-related VT was detected in 6 patients (7.5%). These patients had a lower BMI (17.5 ± 2.0 vs. 23.1 ± 6.6, P = 0.04). There was no difference in age, native conduit or percutaneous valve size, or change in the minimum diameter of the RVOT from pre- to post-PPVI. In the 6 patients, VT was non-sustained and monomorphic at rates between 120 and 170. Five started on β-blockers. No patient required surgical explantation of the valve. Over a median follow-up of 2 years, 4 have weaned off medications and all are free of recurrence of VT with normal Holters.


CONCLUSIONS
PPVI may be associated with transient VT in the acute peri-procedural period. Patients of smaller size may be more susceptible. All patients were managed conservatively and none of the patients had a recurrence, which is suggestive of a transient phenomenon.
The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
Robert W
RW
Loar
The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
Athar M
AM
Qureshi
The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
Christina Y
CY
Miyake
The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
Santiago O
SO
Valdes
The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
Jeffrey J
JJ
Kim
The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
Caridad M
CM
De la Uz
D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification / Q000150:complications; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D011664:Pulmonary Valve / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D013686:Telemetry / Q000379:methods; D013781:Texas; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery
D000889:Anti-Arrhythmia Agents