Sustained atrial arrhythmias in adults late after repair of tetralogy of Fallot

We determined the prevalence of sustained atrial tachyarrhythmia (AT) in ad ults late after repair of tetralogy of Fallot (ToF) and examined its impact on subsequent heart failure, reoperation, and mortality. Ventricular arrhy thmias are associated with increased morbidity and mortality in patients wi th repair of ToF. The clinical impact of AT in this population has not been established. A retrospective cohort study of 242 patients with repaired To F identified 29 patients (prevalence of 12%) with sustained episodes of AT. Patients with repaired ToF but without sustained arrhythmia (n = 213) cons tituted a comparison group. Baseline characteristics and clinical outcomes in the 2 groups were compared. An echocardiographic analysis compared 15 pa tients with AT and 15 matched for age at operation and timing of echocardio graphy. The development of AT was associated with substantial morbidity inc luding congestive heart failure, reoperation, subsequent ventricular tachyc ardia, stroke, and death (combined events, 20 of 29 patients [69%]). The ra te of combined events (congestive heart failure, stroke, and deaths) in the 213 "arrhythmia-free" patients was 30% (64 of 213 patients). Event-free su rvival after repair was 18 +/- 2 years for the AT group and 28 +/- 1 years for the arrhythmia-free group (p <0.001). Patients with AT were older at su rgical repair (25 +/- 16 vs 10 +/- 9 years, p = 0.001), and at most recent assessment were aged 48 +/- 12 vs 32 +/- 10 years (9 = 0.001), The AT group had a higher mean right atrial volume and proportion of significant pulmon ary regurgitation than matched controls. The development of AT in the adult late after ToF repair identifies patients at risk and is associated with o lder age at repair, a higher frequency of hemodynamic abnormalities, and in creased morbidity, (C) 2001 by Excerpta Medica, Inc.