Systematic Electrophysiological Study Prior to Pulmonary Valve Replacement in Tetralogy of Fallot: A Prospective Multicenter Study-Reference-Cited by-同舟云学术

Systematic Electrophysiological Study Prior to Pulmonary Valve Replacement in Tetralogy of Fallot: A Prospective Multicenter Study

Published:2023-06 Issue:6 Volume:16 Page:
ISSN:1941-3149
Container-title:Circulation: Arrhythmia and Electrophysiology
language:en
Short-container-title:Circ: Arrhythmia and Electrophysiology

Author:

Waldmann Victor¹²³⁴^ORCID,Bessière Francis⁵^ORCID,Gardey Kevin⁵,Bakloul Mohamed⁵,Belli Emre⁶^ORCID,Bonnet Damien¹³^ORCID,Chaussade Anne-Solène²,Cohen Sarah⁶⁷,Delasnerie Hubert⁸^ORCID,Dib Nabil⁹,Di Filippo Sylvie⁵,Dulac Arnaud⁵,Hascoët Sébastien¹⁰⁶^ORCID,Henaine Roland⁵,Iserin Laurence²^ORCID,Karsenty Clément⁸,Ladouceur Magalie¹²,Legendre Antoine²³^ORCID,Malekzadeh-Milani Sophie³^ORCID,Mostefa Kara Mansour²,Radojevic Jelena⁶,Ratsimandresy Miarisoa⁸,Marijon Eloi¹⁴^ORCID,Maltret Alice⁶^ORCID,Khairy Paul⁹^ORCID,Combes Nicolas⁶⁸^ORCID

Affiliation:

1. Université Paris Cité, Inserm, PARCC, France (V.W., D.B., M.L., E.M.).

2. Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, France (V.M., A.-S.C., L.I., M.L., A.L., M.M.K.).

3. M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, France (V.W., D.B., A.L., S.M.-M.).

4. Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France (V.W., E.M.).

5. Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., K.G., M.B., S.D.F., A.D., R.H.).

6. Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France (E.B., S.C., S.H., J.R., A.M., N.C.).

7. Université Paris-Saclay, UVSQ, Inserm, CESP U1018, Le Kremlin-Bicêtre, France (S.C.).

8. Pasteur Clinic, Toulouse, France (H.D., C.K., M.R., N.C.).

9. Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Canada (N.D., P.K.).

10. Université Paris Saclay, INSERM UMR S 999 (S.H.).

Abstract

Background: Ventricular arrhythmias and sudden death are recognized complications in tetralogy of Fallot. Electrophysiological studies (EPS) before pulmonary valve replacement (PVR), the most common reintervention in tetralogy of Fallot, could potentially inform therapy to improve arrhythmic outcomes. Methods: A prospective multicenter study was conducted to systematically assess EPS with programmed ventricular stimulation in patients with tetralogy of Fallot referred for PVR from January 2020 to December 2021. A standardized stimulation protocol was used across all centers. Results: A total of 120 patients were enrolled, mean age 39.2±14.5 years, 53.3% males. Sustained ventricular tachycardia was induced in 27 (22.5%) patients. When identifiable, the critical isthmus most commonly implicated (ie, in 90.0%) was between the ventricular septal defect patch and pulmonary annulus. Factors independently associated with inducible ventricular tachycardia were history of atrial arrhythmia (odds ratio, 8.56 [95% CI, 2.43–34.73]) and pulmonary annulus diameter >26 mm (odds ratio, 5.05 [95% CI, 1.47–21.69]). The EPS led to a substantial change in management in 23 (19.2%) cases: 18 (15.0%) had catheter ablation, 3 (2.5%) surgical cryoablation during PVR, and 9 (7.5%) defibrillator implantation. Repeat EPS 5.1 (4.8–6.2) months after PVR was negative in 8 of 9 (88.9%) patients. No patient experienced a sustained ventricular arrhythmia during 13 (6.1–20.1) months of follow-up. Conclusions: Systematically performing programmed ventricular stimulation in patients with tetralogy of Fallot referred for PVR yields a high rate of inducible ventricular tachycardia and carries the potential to alter management. It remains to be determined whether a standardized treatment approach based on the results of EPS will translate into improved outcomes. Registration: URL: https://clinicaltrials.gov/ct2/show/NCT04205461 ; Unique identifier: NCT04205461

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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