title: Ten-year outcomes of monomorphic ventricular tachycardia catheter ablation in repaired tetralogy of Fallot.
abstract: BACKGROUND
  Monomorphic ventricular tachycardia (MVT) is common in adults with repaired tetralogy of Fallot (TOF), and is associated with sudden cardiac death. Management of MVT is not defined, and results of catheter ablation (CA) are limited.
  
  
  OBJECTIVE
  To evaluate long-term outcomes of MVT CA in repaired TOF.
  
  
  METHODS
  Thirty-four patients (mean age 32±10.3 years; 59% male) with repaired TOF underwent CA for symptomatic MVT between 1990 and 2012 in our centre; direct-current ablation (DCA) was used in 6%, radiofrequency followed by DCA in 29% and radiofrequency alone in 65%.
  
  
  RESULTS
  Right ventricular (RV) dysfunction was present in 35% and left ventricular (LV) dysfunction in 21%. Mean numbers of clinical and induced MVTs were 1 and 2, respectively. Mean VT rate was 225±95bpm. Ablation targeted a single site (range 1-2), which was RV outflow tract in 85%. Primary success, defined as ventricular tachycardia (VT) termination during CA and final non-inducibility, was obtained in 82%. Seven patients (21%) required redo ablation in the first 3 months (before 2004; DCA). No death related to CA occurred. Mean follow-up time was 9.5±5.2 years. Antiarrhythmic therapy was discontinued in 71%. There were two cases of sudden cardiac death and four VT recurrences. Freedom from death and arrhythmia recurrence was 94% at 5 years, 81% at 10 years and 70% at 20 years. Global survival was 91% at 20 years. Baseline LV ejection fraction<60% was significantly associated with ventricular arrhythmia recurrence (hazard ratio 16.4, 95% confidence interval 1.8-147; P=0.01).
  
  
  CONCLUSIONS
  CA can safely address macroreentrant MVT in repaired TOF patients with an acceptable long-term rate of recurrence in this high-risk population. Anatomical classification of isthmuses with electroanatomical mapping provides reproducible endpoints for CA. Attention should be given to LV systolic function in risk assessment and selection of candidates for implantable cardioverter-defibrillator.
authors.affiliation: Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Mikaël
authors.initials: M
authors.lastname: Laredo
authors.affiliation: Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Frank
authors.affiliation: Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Waintraub
authors.affiliation: Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Gandjbakhch
authors.affiliation: Service de Cardiologie Congénitale de l'Adulte, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Iserin
authors.affiliation: Service de Cardiologie Pédiatrique et Congénitale, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Hascoët
authors.affiliation: Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Himbert
authors.affiliation: Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Gallais
authors.affiliation: Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Hidden-Lucet
authors.affiliation: Unité de Rythmologie, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France. Electronic address: guillaume.duthoit@aphp.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Duthoit
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult
keywords: Ablation par cathéter; Catheter ablation; Défibrillateur automatique implantable; Implantable cardioverter-defibrillator; Mort subite cardiaque; Sudden cardiac death; Tachycardie ventriculaire; Tetralogy of Fallot; Tétralogie de Fallot; Ventricular tachycardia