Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: A multicentre study

Michael A. Gatzoulis, Seshadri Balaji, Steven A. Webber, Samuel C. Siu, John S. Hokanson, Christine Poile, Mark Rosenthal, Makoto Nakazawa, James H. Moller, Paul C. Gillette, Gary D. Webb, Andrew N. Redington

Research output: Contribution to journalArticle

1104 Citations (Scopus)

Abstract

Background: Ventricular arrhythmia and sudden cardiac death late after repair of tetralogy of Failer are devastating complications in adult survivors of early surgery, but their prediction remains difficult. Methods: We examined surgical, electrocardiographic, and late haemodynamic data, and their relation to clinical arrhythmia and sudden death occurring over 10 years, in a multicentre cohort of patients with repaired tetralogy, who were alive in 1985. Results: Of 793 patients (mean age at repair 8·2 years [SD 8], mean time from repair 21·1 years [8·7]) who entered the study, 33 patients developed sustained monomorphic ventricular tachycardia, 16 died suddenly, and 29 had new-onset sustained atrial flutter or fibrillation. Electrocardiographic markers (QRS duration, QRS rate of change between 1985 and 1995) were significantly greater in the ventricular tachycardia and sudden-death groups. Older age at repair was associated with a higher risk of sudden death and atrial tachyarrhythmia. Pulmonary regurgitation was the main underlying haemodynamic lesion for patients with ventricular tachycardia and sudden death, whereas tricuspid regurgitation was for those with atrial flutter/fibrillation. Despite adverse haemodynamics, no patient who died suddenly had undergone late reoperation. Conclusion: Arrhythmia and sudden death are important late sequelae for patients after repair of tetralogy of Fallot. The electrophysiological and haemodynamic substrate of sudden death resembled that of sustained ventricular tachycardia, with pulmonary regurgitation being the predominant haemodynamic lesion. Preservation or restoration of pulmonary valve function may thus reduce the risk of sudden death. Furthermore, electrocardiographic markers can help to identify patients at risk.

Original languageEnglish (US)
Pages (from-to)975-981
Number of pages7
JournalLancet
Volume356
Issue number9234
StatePublished - Sep 16 2000
Externally publishedYes

Fingerprint

Tetralogy of Fallot
Sudden Cardiac Death
Sudden Death
Multicenter Studies
Cardiac Arrhythmias
Ventricular Tachycardia
Hemodynamics
Pulmonary Valve Insufficiency
Atrial Flutter
Atrial Fibrillation
Pulmonary Valve
Tricuspid Valve Insufficiency
Reoperation
Tachycardia
Survivors

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gatzoulis, M. A., Balaji, S., Webber, S. A., Siu, S. C., Hokanson, J. S., Poile, C., ... Redington, A. N. (2000). Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: A multicentre study. Lancet, 356(9234), 975-981.

Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot : A multicentre study. / Gatzoulis, Michael A.; Balaji, Seshadri; Webber, Steven A.; Siu, Samuel C.; Hokanson, John S.; Poile, Christine; Rosenthal, Mark; Nakazawa, Makoto; Moller, James H.; Gillette, Paul C.; Webb, Gary D.; Redington, Andrew N.

In: Lancet, Vol. 356, No. 9234, 16.09.2000, p. 975-981.

Research output: Contribution to journalArticle

Gatzoulis, MA, Balaji, S, Webber, SA, Siu, SC, Hokanson, JS, Poile, C, Rosenthal, M, Nakazawa, M, Moller, JH, Gillette, PC, Webb, GD & Redington, AN 2000, 'Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: A multicentre study', Lancet, vol. 356, no. 9234, pp. 975-981.
Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: A multicentre study. Lancet. 2000 Sep 16;356(9234):975-981.
Gatzoulis, Michael A. ; Balaji, Seshadri ; Webber, Steven A. ; Siu, Samuel C. ; Hokanson, John S. ; Poile, Christine ; Rosenthal, Mark ; Nakazawa, Makoto ; Moller, James H. ; Gillette, Paul C. ; Webb, Gary D. ; Redington, Andrew N. / Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot : A multicentre study. In: Lancet. 2000 ; Vol. 356, No. 9234. pp. 975-981.
@article{ab91d8c733704e07b9f7c188b4db1c8e,
title = "Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: A multicentre study",
abstract = "Background: Ventricular arrhythmia and sudden cardiac death late after repair of tetralogy of Failer are devastating complications in adult survivors of early surgery, but their prediction remains difficult. Methods: We examined surgical, electrocardiographic, and late haemodynamic data, and their relation to clinical arrhythmia and sudden death occurring over 10 years, in a multicentre cohort of patients with repaired tetralogy, who were alive in 1985. Results: Of 793 patients (mean age at repair 8·2 years [SD 8], mean time from repair 21·1 years [8·7]) who entered the study, 33 patients developed sustained monomorphic ventricular tachycardia, 16 died suddenly, and 29 had new-onset sustained atrial flutter or fibrillation. Electrocardiographic markers (QRS duration, QRS rate of change between 1985 and 1995) were significantly greater in the ventricular tachycardia and sudden-death groups. Older age at repair was associated with a higher risk of sudden death and atrial tachyarrhythmia. Pulmonary regurgitation was the main underlying haemodynamic lesion for patients with ventricular tachycardia and sudden death, whereas tricuspid regurgitation was for those with atrial flutter/fibrillation. Despite adverse haemodynamics, no patient who died suddenly had undergone late reoperation. Conclusion: Arrhythmia and sudden death are important late sequelae for patients after repair of tetralogy of Fallot. The electrophysiological and haemodynamic substrate of sudden death resembled that of sustained ventricular tachycardia, with pulmonary regurgitation being the predominant haemodynamic lesion. Preservation or restoration of pulmonary valve function may thus reduce the risk of sudden death. Furthermore, electrocardiographic markers can help to identify patients at risk.",
author = "Gatzoulis, {Michael A.} and Seshadri Balaji and Webber, {Steven A.} and Siu, {Samuel C.} and Hokanson, {John S.} and Christine Poile and Mark Rosenthal and Makoto Nakazawa and Moller, {James H.} and Gillette, {Paul C.} and Webb, {Gary D.} and Redington, {Andrew N.}",
year = "2000",
month = "9",
day = "16",
language = "English (US)",
volume = "356",
pages = "975--981",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "9234",

}

TY - JOUR

T1 - Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot

T2 - A multicentre study

AU - Gatzoulis, Michael A.

AU - Balaji, Seshadri

AU - Webber, Steven A.

AU - Siu, Samuel C.

AU - Hokanson, John S.

AU - Poile, Christine

AU - Rosenthal, Mark

AU - Nakazawa, Makoto

AU - Moller, James H.

AU - Gillette, Paul C.

AU - Webb, Gary D.

AU - Redington, Andrew N.

PY - 2000/9/16

Y1 - 2000/9/16

N2 - Background: Ventricular arrhythmia and sudden cardiac death late after repair of tetralogy of Failer are devastating complications in adult survivors of early surgery, but their prediction remains difficult. Methods: We examined surgical, electrocardiographic, and late haemodynamic data, and their relation to clinical arrhythmia and sudden death occurring over 10 years, in a multicentre cohort of patients with repaired tetralogy, who were alive in 1985. Results: Of 793 patients (mean age at repair 8·2 years [SD 8], mean time from repair 21·1 years [8·7]) who entered the study, 33 patients developed sustained monomorphic ventricular tachycardia, 16 died suddenly, and 29 had new-onset sustained atrial flutter or fibrillation. Electrocardiographic markers (QRS duration, QRS rate of change between 1985 and 1995) were significantly greater in the ventricular tachycardia and sudden-death groups. Older age at repair was associated with a higher risk of sudden death and atrial tachyarrhythmia. Pulmonary regurgitation was the main underlying haemodynamic lesion for patients with ventricular tachycardia and sudden death, whereas tricuspid regurgitation was for those with atrial flutter/fibrillation. Despite adverse haemodynamics, no patient who died suddenly had undergone late reoperation. Conclusion: Arrhythmia and sudden death are important late sequelae for patients after repair of tetralogy of Fallot. The electrophysiological and haemodynamic substrate of sudden death resembled that of sustained ventricular tachycardia, with pulmonary regurgitation being the predominant haemodynamic lesion. Preservation or restoration of pulmonary valve function may thus reduce the risk of sudden death. Furthermore, electrocardiographic markers can help to identify patients at risk.

AB - Background: Ventricular arrhythmia and sudden cardiac death late after repair of tetralogy of Failer are devastating complications in adult survivors of early surgery, but their prediction remains difficult. Methods: We examined surgical, electrocardiographic, and late haemodynamic data, and their relation to clinical arrhythmia and sudden death occurring over 10 years, in a multicentre cohort of patients with repaired tetralogy, who were alive in 1985. Results: Of 793 patients (mean age at repair 8·2 years [SD 8], mean time from repair 21·1 years [8·7]) who entered the study, 33 patients developed sustained monomorphic ventricular tachycardia, 16 died suddenly, and 29 had new-onset sustained atrial flutter or fibrillation. Electrocardiographic markers (QRS duration, QRS rate of change between 1985 and 1995) were significantly greater in the ventricular tachycardia and sudden-death groups. Older age at repair was associated with a higher risk of sudden death and atrial tachyarrhythmia. Pulmonary regurgitation was the main underlying haemodynamic lesion for patients with ventricular tachycardia and sudden death, whereas tricuspid regurgitation was for those with atrial flutter/fibrillation. Despite adverse haemodynamics, no patient who died suddenly had undergone late reoperation. Conclusion: Arrhythmia and sudden death are important late sequelae for patients after repair of tetralogy of Fallot. The electrophysiological and haemodynamic substrate of sudden death resembled that of sustained ventricular tachycardia, with pulmonary regurgitation being the predominant haemodynamic lesion. Preservation or restoration of pulmonary valve function may thus reduce the risk of sudden death. Furthermore, electrocardiographic markers can help to identify patients at risk.

UR - http://www.scopus.com/inward/record.url?scp=0034675250&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034675250&partnerID=8YFLogxK

M3 - Article

C2 - 11041398

AN - SCOPUS:0034675250

VL - 356

SP - 975

EP - 981

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9234

ER -