Nonsustained ventricular tachycardia was common early after Harmony transcatheter pulmonary valve replacement (50% on postimplant telemetry) but diminished rapidly to 14% on follow-up monitoring.
Observational (n=54)
What is the incidence and clinical course of ventricular arrhythmias after transcatheter pulmonary valve replacement with the Harmony valve?
Nonsustained ventricular tachycardia is common early after Harmony TPVR but is typically infrequent, diminishes rapidly after discharge, and is not associated with major arrhythmic events or sustained VT at mid-term follow-up.
BACKGROUND: Varying rates of nonsustained ventricular tachycardia (NSVT) have been reported early after transcatheter pulmonary valve replacement (TPVR) with the Harmony valve, but data regarding rhythm outcomes beyond hospital discharge are limited. This study aims to characterize ventricular arrhythmias after Harmony TPVR from implant through mid-term follow-up. METHODS: Ventricular arrhythmia data from postimplant telemetry and follow-up extended rhythm monitoring (ERM) were analyzed after Harmony TPVR. RESULTS: Fifty-four patients with tetralogy of Fallot (n=39), valvar pulmonary stenosis (n=10), or pulmonary atresia with intact ventricular septum (n=5) were studied; 22% had prior NSVT and 24% were on prior rhythm medication. On postimplant telemetry, 27 patients (50%) had NSVT, including 1 who had torsade de pointes, but most had <5 episodes. Pre-TPVR NSVT or rhythm medications, diagnosis other than tetralogy, and substantial device contact with the myocardium were associated with more frequent NSVT on telemetry. Ten patients (19%) were started on a new antiarrhythmic medication. On discharge ERM, 37% of patients had NSVT, most with <5 episodes and only 13% with NSVT beyond 5 days post-discharge. On follow-up ERM, 14% of patients had a single episode of NSVT and 1 had 5 episodes. During follow-up, antiarrhythmic medications were discontinued in 8 of 10 patients and no patients died or had sustained ventricular tachycardia. CONCLUSIONS: NSVT and ventricular ectopy were common early after TPVR but were infrequent in most cases and diminished rapidly after discharge. The incidence of NSVT on follow-up ERM was similar to preimplant incidence. Few patients had antiarrhythmic medications initiated, and most were discontinued on follow-up. There were no major arrhythmic events after discharge.
Yang et al. (Fri,) conducted a observational in Tetralogy of Fallot, valvar pulmonary stenosis, or pulmonary atresia with intact ventricular septum requiring TPVR (n=54). Harmony transcatheter pulmonary valve replacement was evaluated on Nonsustained ventricular tachycardia (NSVT) on postimplant telemetry. Nonsustained ventricular tachycardia was common early after Harmony transcatheter pulmonary valve replacement (50% on postimplant telemetry) but diminished rapidly to 14% on follow-up monitoring.