Radiofrequency catheter ablation for ventricular tachycardia in tetralogy of fallot: A systematic review

Ventricular arrhythmias in adult patients following surgical repair of tetralogy of Fallot (TOF) may be challenging to manage and life-threatening. Ventricular tachycardia (VT) is the leading cause of sudden cardiac death in this patient population. Radiofrequency catheter ablation (RFCA) constitutes an important treatment modality for VT. The present study summarizes the outcomes of repaired TOF patients undergoing RFCA for resistant VT. A systematic literature search of the PubMed and Cochrane databases was performed with respect to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight studies including 106 patients were analyzed. Mean patient age at the time of RFCA was 39.0 ​± ​15.9 years, male:female ratio was 1.97:1. Programmed ventricular stimulation induced sustained VT in 81.6% (95%CI: 72.7–88.1) of patients. VT recurred shortly after the procedure in 16% (95%CI: 10.2–24.3) and during follow-up in 12.2% (95%CI: 6.3–21.7). The post-procedural use of amiodarone and beta-blockers therapy was decreased from 40% (95%CI: 30.3–51.1) to 20% (95%CI: 8.4–39.6) and from 58% (95%CI: 44.2–70.6) to 28% (95%CI: 14.1–47.8) of patients, respectively. A repeat RFCA procedure was required in 17.5% (95%CI: 11.1–26.4). No in-hospital deaths occurred, while overall mortality rate during a mean follow-up of 73.5 ​± ​61.4 months was 3% (95%CI: 0.2–10.9). RFCA can control ventricular dysrhythmias in over 80% of the cases, with zero in-hospital and low overall mortality, while substantially reducing the need for antiarrhythmic drugs.