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.
1
,
2
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.
1
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.Keywords
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References
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- Implantable cardioverter-defibrillators in tetralogy of Fallot.Circulation. 2008; 117: 363-370
- Catheter ablation of ventricular tachycardia after repair of congenital heart disease: electroanatomic identification of the critical right ventricular isthmus.Circulation. 2007; 116: 2241-2252
- Value of programmed ventricular stimulation after tetralogy of Fallot repair: a multicenter study.Circulation. 2004; 109: 1994-2000
- 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
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Article info
Publication history
Published online: March 02, 2009
Accepted:
February 25,
2009
Received:
January 31,
2009
Footnotes
Supported in part by the Canada Research Chair in Electrophysiology and Adult Congenital Heart Disease (Dr. Khairy).
Dr. Khairy has received honoraria from St. Jude Medical. Dr. Stevenson has received honoraria from Biosense Webster, Boston Scientific, Medtronic, and St. Jude Medical and has served as a consultant for Biosense Webster.
Identification
Copyright
© 2009 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
