Key result
Pre-PVR EP assessment in repaired tetralogy of Fallot preserves access for VA catheter ablation.
Why the study?
Patients with repaired tetralogy of Fallot remain at risk for sudden cardiac death from sustained monomorphic ventricular tachycardia, and pulmonary valve replacement may cause loss of catheter ablation accessibility to slow-conducting anatomical isthmuses.
Should patients with repaired tetralogy of Fallot undergo electrophysiological assessment before pulmonary valve replacement to address ventricular arrhythmia substrates?
Should patients with repaired tetralogy of Fallot undergo electrophysiological assessment before pulmonary valve replacement to address ventricular arrhythmia substrates?
Proactive electrophysiological assessment before pulmonary valve replacement in repaired tetralogy of Fallot is favored to ensure accessibility for catheter ablation of ventricular arrhythmia substrates.
May support pre-PVR EP assessment in repaired TOF; leaves open need for prospective validation.
Despite advances in surgical repair and medical management, the risk of sudden cardiac death (SCD) from sustained monomorphic ventricular tachycardia (SMVT) remains of concern in patients with repaired tetralogy of Fallot (rTOF). Slow-conducting anatomical isthmuses (SCAI) bordered by electrically inert barriers related to patch material, valve annuli, and right ventricular outflow tract incision are the dominant substrate for SMVT. The potential loss of accessibility to SCAI by catheter ablation after surgical or transcatheter pulmonary valve replacement (PVR) has been recognized, favoring electrophysiological assessment before reintervention (Figure 1).
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Zeppenfeld et al. (2025) conducted a review in Repaired tetralogy of Fallot (rTOF). Electrophysiological assessment was evaluated. Electrophysiological assessment before pulmonary valve replacement is favored in repaired tetralogy of Fallot to maintain accessibility for catheter ablation of ventricular arrhythmias.
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