SUSTAINED VENTRICULAR-TACHYCARDIA IN ADULT PATIENTS LATE AFTER REPAIROF TETRALOGY OF FALLOT

Objectives. We sought to determine the features associated with sustai ned monoform ventricular tachycardia (VT) in adult patients late after repair of tetralogy of Fallot (TOF) and to review their management, B ackground. Patients with repair of TOP are at risk for sudden death, R isk factors for ventricular arrhythmia have been identified from patie nts with ventricular ectopic beats because of the low prevalence of su stained VT. Methods. From a retrospective chart review of patients ass essed between January 1990 and December 1994, 18 adult patients with V T were identified and compared with 192 with repaired TOF free of sust ained arrhythmia, Results. There was no significant difference in age at repair, age at follow-up or operative history, Patients with VT had frequent ventricular ectopic beats (6 of 9 vs. 21 of 101), low cardia c index ([mean +/- SD] 2.4 +/- 0.4 vs. 3.0 +/- 0.8) and more structura l abnormalities of the right ventricle (outflow tract aneurysms and pu lmonary or tricuspid regurgitation) than control patients. Electrophys iologic map-guided operation was performed in 10 of 14 patients who re quired reoperation, VT has reoccurred in three of these patients, Four patients did not undergo operation (three received amiodarone; one un derwent defibrillator implantation), Trm patients with VT also had sev ere heart failure and died, Conclusions. Most patients with VT late af ter repair of TOF have outflow tract aneurysms or pulmonary regurgitat ion, or both. These patients have a greater frequency of ventricular e ctopic heats than arrhythmia-free patients after repair of TOP, A comb ined approach of correcting significant structural abnormalities (pulm onary valve replacement or right ventricular aneurysmectomy, or both) with intraoperative electrophysiologic-guided ablation may reduce the potential risk of deterioration in ventricular function and enable arr hythmia management to be optimized. (C) 1997 by the American College o f Cardiology.