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Catheter ablation in tetralogy of Fallot

      Tetralogy of Fallot is the most common form of cyanotic heart disease, accounting for approximately 10% of congenital heart defects. Corrective surgery involves atrial and/or ventricular incisions and patches that, when combined with altered hemodynamics, predispose to the late onset of arrhythmias.
      • Gatzoulis M.A.
      • Balaji S.
      • Webber S.A.
      • et al.
      Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study.
      • Karamlou T.
      • McCrindle B.W.
      • Williams W.G.
      Surgery insight: late complications following repair of tetralogy of Fallot and related surgical strategies for management.
      In a multicenter cohort followed up for 35 years after corrective surgery, sustained atrial and ventricular tachyarrhythmias occurred in 10% and 12% of patients, respectively.
      • Gatzoulis M.A.
      • Balaji S.
      • Webber S.A.
      • et al.
      Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study.
      Macroreentrant right atrial tachycardia is the most common atrial arrhythmia. Ventricular tachycardia involving right ventricular scar is an important cause of sudden death. Successful and safe catheter ablation is facilitated by an appreciation for anatomical particularities, surgical details, and frequently encountered arrhythmogenic substrates and targets. Pre-procedural planning should include a careful review of imaging studies, original surgical and interventional notes, and all documented tachyarrhythmias.

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      References

        • Gatzoulis M.A.
        • Balaji S.
        • Webber S.A.
        • et al.
        Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study.
        Lancet. 2000; 356: 975-981
        • Karamlou T.
        • McCrindle B.W.
        • Williams W.G.
        Surgery insight: late complications following repair of tetralogy of Fallot and related surgical strategies for management.
        Nat Clin Pract Cardiovasc Med. 2006; 3: 611-622
        • Bashore T.M.
        Adult congenital heart disease: right ventricular outflow tract lesions.
        Circulation. 2007; 115: 1933-1947
        • Harrison D.A.
        • Siu S.C.
        • Hussain F.
        • et al.
        Sustained atrial arrhythmias in adults late after repair of tetralogy of Fallot.
        Am J Cardiol. 2001; 87: 584-588
        • de Groot N.M.
        • Schalij M.J.
        • Zeppenfeld K.
        • et al.
        Voltage and activation mapping: how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease.
        Circulation. 2003; 108: 2099-2106
        • Khairy P.
        • Harris L.
        • Landzberg M.J.
        • et al.
        Implantable cardioverter-defibrillators in tetralogy of Fallot.
        Circulation. 2008; 117: 363-370
        • Zeppenfeld K.
        • Schalij M.J.
        • Bartelings M.M.
        • et al.
        Catheter ablation of ventricular tachycardia after repair of congenital heart disease: electroanatomic identification of the critical right ventricular isthmus.
        Circulation. 2007; 116: 2241-2252
        • Khairy P.
        • Landzberg M.J.
        • Gatzoulis M.A.
        • et al.
        Value of programmed ventricular stimulation after tetralogy of Fallot repair: a multicenter study.
        Circulation. 2004; 109: 1994-2000
        • Soejima K.
        • Stevenson W.G.
        • Maisel W.H.
        • et al.
        Electrically unexcitable scar mapping based on pacing threshold for identification of the reentry circuit isthmus: feasibility for guiding ventricular tachycardia ablation.
        Circulation. 2002; 106: 1678-1683
        • Stevenson W.G.
        • Friedman P.L.
        • Sager P.T.
        • et al.
        Exploring postinfarction reentrant ventricular tachycardia with entrainment mapping.
        J Am Coll Cardiol. 1997; 29: 1180-1189