October 1, 2016Open Access
Percutaneous Pulmonary Valve Implantation Alters Electrophysiologic Substrate
Key Result
Percutaneous pulmonary valve implantation significantly shortened the median corrected QT interval from 463 ms to 442 ms at medium-term follow-up and reduced the prevalence of nonsustained ventricular tachycardia.
Study Design
Type
Cohort (n=106)
Multicenter
No
Structured PICO
Does percutaneous pulmonary valve implantation improve the electrophysiologic substrate and arrhythmia burden in patients with congenital heart disease?
P
Population
106 patients (median age 20.7 years, 38% female) with congenital heart disease and right ventricular outflow tract dysfunction who underwent percutaneous pulmonary valve implantation, followed for a median of 28 months.
E
Exposure
Percutaneous pulmonary valve implantation (PPVI)
C
Comparator
Pre-PPVI baseline (retrospective self-control)
O
Outcome
Short- and medium-term electrophysiologic substrate changes and postprocedure arrhythmias (including NSVT, PVCs, AF/AFL, QRS duration, and corrected QT interval)surrogate
Percutaneous pulmonary valve implantation appears to favorably alter the electrophysiologic substrate in congenital heart disease patients, reducing the prevalence of NSVT and shortening QTc at midterm follow-up despite transient new post-procedural arrhythmias.
Main Result
Absolute Event Rate: 442% vs 463%
p-value: p=<0.001
Limitations
- Single-center retrospective study with patient attrition over time
- Heterogeneous cohort in anatomical lesions, hemodynamics, and clinical status
- No uniform protocol for monitoring of PVCs and NSVT over the follow-up period
- Changes to the QTc may be secondary to anesthesia, other medications, or electrolyte anomalies
Abstract
BACKGROUND: Percutaneous pulmonary valve implantation (PPVI) is first-line therapy for some congenital heart disease patients with right ventricular outflow tract dysfunction. The hemodynamics improvements after PPVI are well documented, but little is known about its effects on the electrophysiologic substrate. The objective of this study is to assess the short- and medium-term electrophysiologic substrate changes and elucidate postprocedure arrhythmias. METHODS AND RESULTS: A retrospective chart review of patients undergoing PPVI from May 2010 to April 2015 was performed. A total of 106 patients underwent PPVI; most commonly these patients had tetralogy of Fallot (n=59, 55%) and pulmonary insufficiency (n=60, 57%). The median follow-up time was 28 months (7-63 months). Pre-PPVI, 25 patients (24%) had documented arrhythmias: nonsustained ventricular tachycardia (NSVT) (n=9, 8%), frequent premature ventricular contractions (PVCs) (n=6, 6%), and atrial fibrillation/flutter (AF/AFL) (n=10, 9%). Post-PPVI, arrhythmias resolved in 4 patients who had NSVT (44%) and 5 patients who had PVCs (83%). New arrhythmias were seen in 16 patients (15%): 7 NSVT, 8 PVCs, and 1 AF/AFL. There was resolution at medium-term follow-up in 6 (86%) patients with new-onset NSVT and 7 (88%) patients with new-onset PVCs. There was no difference in QRS duration pre-PPVI, post-PPVI, and at medium-term follow-up (P=0.6). The median corrected QT lengthened immediately post-PPVI but shortened significantly at midterm follow-up (P<0.01). CONCLUSIONS: PPVI reduced the prevalence of NSVT. The majority of postimplant arrhythmias resolve by 6 months of follow-up.