Key result
Absent sinus node dysfunction predicts ~23-fold higher odds of tachyarrhythmia control without hemodynamic intervention in repaired TOF.
Why the study?
Supraventricular and ventricular tachyarrhythmias are major concerns after repair of tetralogy of Fallot, and the impact of hemodynamic interventions on these arrhythmias requires evaluation.
Do hemodynamic interventions improve arrhythmia control in repaired tetralogy of Fallot patients with tachyarrhythmia?
Observational (n=66)
No
Do hemodynamic interventions improve arrhythmia control in repaired tetralogy of Fallot patients with tachyarrhythmia?
Odds Ratio: 23.2 (95% CI 1.8–845.2)
p-value: p=0.02
Hemodynamic interventions such as surgery, catheter-based intervention, and pacemaker implantation can improve arrhythmia control in repaired TOF patients with intractable tachyarrhythmia.
May guide conservative management in repaired tetralogy of Fallot without sinus node dysfunction; leaves open hemodynamic intervention benefit overall.
BACKGROUND: Supraventricular and ventricular tachyarrhythmias (SVT, VT) are major concerns after repair of tetralogy of Fallot (TOF). This study evaluated the impact of comprehensive treatment, including hemodynamic interventions such as surgery, catheter-based intervention and pacemaker implantation (PMI), on tachyarrhythmia in repaired TOF patients. METHODS AND RESULTS: Of 66 repaired TOF patients with tachyarrhythmia (age at onset, 23±11 years), 29 patients had sustained SVT, 21 had sustained or non-sustained VT, and 16 had both (SVT+VT). Successful treatment with catheter-directed ablation and/or anti-arrhythmic drugs (AADs) alone was achieved in 31 (69%) and partially achieved in 6 (13%) of 45 patients. Surgery, catheter-based intervention, and/or PMI were performed in 21 (32%) of 66 patients and resulted in complete control of the arrhythmia in 8 (38%) and partial control in 7 (33%) of these 21 patients, 20 (95%) of whom were receiving AADs. Patients with successfully controlled tachyarrhythmia in response to catheter ablation and/or AADs without hemodynamic intervention had a significantly higher probability of absence of sinus node dysfunction (odds ratio [OR], 23.2; 95% confidence interval [CI], 1.8-845.2; P=0.02) and lone intra-atrial reentrant tachycardia (OR, 12.4; 95% CI: 1.3-278.7; P=0.03). CONCLUSIONS: Hemodynamic interventions resulted in an improvement in outcomes in repaired TOF patients with tachyarrhythmia. To effectively manage intractable tachyarrhythmia with hemodynamic abnormalities, it is essential to understand hemodynamics and consider hemodynamic intervention.
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Miyazaki et al. (2012) conducted an observational in Tachyarrhythmia after repair of tetralogy of Fallot (n=66). Absence of sinus node dysfunction vs. Presence of sinus node dysfunction was evaluated on Complete or partial control of tachyarrhythmia without hemodynamic intervention (OR 23.2, 95% CI 1.8-845.2, p=0.02). In patients with repaired tetralogy of Fallot, the absence of sinus node dysfunction was a strong predictor of successfully controlled tachyarrhythmia without hemodynamic intervention (OR 23.2).
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