Tetralogy of Fallot: electrophysiology-guided surgical ablation during pulmonary valve replacement.
Electrophysiological-guided ablation during pulmonary valve replacement far outperforms empiric ablation for eliminating inducible ventricular tachycardia
Tetralogy of Fallot: electrophysiology-guided surgical ablation during pulmonary valve replacement.
Adults with repaired tetralogy of Fallot (tetralogy of Fallot) face long-term risks of ventricular tachycardia (ventricular tachycardia) and sudden cardiac death (sudden cardiac death).
This study assessed whether pre-operative electrophysiological (electrophysiological) testing with targeted intraoperative cryoablation of identified anatomical isthmuses during pulmonary valve replacement is associated with a reduction in post-operative ventricular tachycardia inducibility and long-term risk of clinical ventricular tachycardia/sudden cardiac death.
In this prospective multicentre cohort study, consecutive adults with tetralogy of Fallot undergoing surgical pulmonary valve replacement (2005-22) underwent standardized pre-operative electrophysiological studies.
Electrophysiological-guided ablation was far more likely to eliminate inducible ventricular tachycardia than empiric ablation
Among 204 patients (age 35.5 ± 13.1 years, 43.1% female), 91 (45.1%) had inducible ventricular tachycardia.
Persistent post-operative inducibility was associated with increased hazard of ventricular tachycardia/sudden cardiac death compared to patients without inducible ventricular tachycardia pre-operatively [adjusted hazard ratio (HR) 5.3, 95% CI 1.8-16.0, P = .003], over a median 10.2-year follow-up.
In adults with repaired tetralogy of Fallot undergoing pulmonary valve replacement, inducible ventricular tachycardia is common.
An electrophysiological-guided surgical strategy is associated with greater post-operative non-inducibility and improved long-term arrhythmic outcomes compared with empiric ablation.