Preventing sudden death after repair of tetralogy of Fallot: Complex therapy for complex patients

Arrhythmias in Tetralogy of Fallot. Sudden arrhythmic death in patients wit h repaired tetralogy of Fallot or its variants has a variety of causes, Con sequently, it can serve as a paradigm for management of potentially maligna nt arrhythmias in all pediatric patients, particularly with regard to the u se of nonpharmacologic therapy for management. Five cases are presented as touchpoints for discussion and demonstrate a number of important issues con cerning the assessment and reduction of sudden cardiac death risk in these patients. First, there are no clinical parameters that can be used to accur ately assess risk. Second, pharmacologic agents alone rarely are adequate t herapy. Third, catheter ablation and antitachycardia devices continue to pl ay an ever increasing role in management of these patients, and, finally, a dditional data are necessary to establish clear management guidelines in pa tients with congenital heart disease at risk for arrhythmic death.