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Ventricular arrhythmias after fibroma resection: Are patients still at risk?

Published:October 10, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.003

      Background

      Ventricular fibromas frequently present with life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) in children. The long-term risk of sustained ventricular arrhythmias after surgical resection is unknown.

      Objectives

      The aims of this study were to quantify the VT/VF risk after surgical resection and to examine the results of early (during index surgical hospitalization) and late (≥3 months after surgery) postoperative ventricular stimulation (V-stim) studies.

      Methods

      We performed a retrospective cohort study of all patients with ventricular fibromas who underwent surgical resection at our institution (2000–2020). The primary outcome was defined as recurrent VT/VF ≥3 months after index surgical resection.

      Results

      Forty-six patients with a median age at surgery of 2 years (range 0.3–18.9 years) formed our study cohort. Indications for surgery included cardiac arrest in 11 (24%), sustained VT in 16 (35%), premature ventricular contractions/nonsustained VT in 10 (22%), and hemodynamic abnormalities in 9 (20%). Of the 11 patients who presented with cardiac arrest, 4 underwent pre-resection implantable cardioverter-defibrillator (ICD) implantation, all of which were explanted at the time of surgery. An early postoperative V-stim study was performed in 26 (57%) patients, and all were negative for inducible VT/VF. Of the 13 late postoperative V-stim studies, 3 were positive: 2 underwent ICD implantation and 1 was initiated on amiodarone and underwent loop recorder implantation. At the time of last follow-up (median 1.5 years; range 0.3–16.5 years), 45 (98%) were free of clinical VT/VF and no patient with an ICD has received an appropriate shock.

      Conclusion

      Surgical resection of ventricular fibromas significantly reduces the risk of life-threatening arrhythmias in children; however, a small number of patients remain vulnerable.

      Keywords

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