The Impact of Pulmonic Valve Replacement on Ventricular Arrhythmias Associated With Tetralogy of Fallot Patients

Background: There is no consensus on the timing of pulmonary valve replacement (PVR) in these patients or the impact of PVR on the subsequent development of fatal arrhythmias such as ventricular tachycardia. We have assessed the incidence of ventricular arrhythmias in patients with PVR versus those without PVR in patients with TOF. Methods: We performed an aggregate data meta-analysis on 12 studies with 1,740 patients on the development of ventricular arrhythmias following initial repair, comparing patients who had PVR years after initial repair versus those who had no further intervention. We also performed a meta-regression analysis to evaluate the effect of preoperative and postoperative right ventricular end-diastolic volume (RV-EDV) and QRS on the incidence of ventricular arrhythmias. Results: Among 1,740 patients with TOF, ventricular arrhythmias in patients with PVR were reduced by almost 60% than patients without PVR (OR 0.40, 95% CI 0.219-0.725, p <0.003). Similar results were noted in both fixed- and random-effects models. The standardized difference in means for RV-EDV after PVR showed a statistically significant reduction after PVR (random-effects model: -1.44, SE = 0.188, p < 0.0001). Patients also had a statistically significant increase in RV-EF and reduction QRS as well as increase in RV-EF following PVR. Neither pre-operative RV-EDV nor QRS duration was associated with statistically significant coefficients for changes in the incidence of VT by meta-regression. Conclusion: For TOF survivors after repair, there was a markedly reduced rate of ventricular arrhythmias in patients who received PVR compared to patients without PVR.