Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1994 Dec;72(6):580–583. doi: 10.1136/hrt.72.6.580

Ventricular late potentials and spontaneous ventricular arrhythmias after surgical repair of tetralogy of Fallot: do they have prognostic value?

D Giroud 1, M Zimmermann 1, R Adamec 1, I Oberhänsli 1, B Friedli 1
PMCID: PMC1025648  PMID: 7857743

Abstract

OBJECTIVE--To determine the prognostic significance of ventricular late potentials and spontaneous ventricular arrhythmias detected early after surgical repair of tetralogy of Fallot. DESIGN--Prospective observational. SETTING--Cardiology department of a teaching hospital. METHODS--Between June 1984 and June 1991, 104 children (63 boys, 41 girls) were studied by signal averaging and 24 hour ambulatory monitoring after surgical repair of tetralogy of Fallot. Mean (SD) age at operation was 6 (3) years, mean interval between operation and evaluation was 8 (25) months, and the follow up after evaluation was one to 88 (mean 30) months. RESULTS--Ventricular late potentials were detected in 24/104 patients (23%) and spontaneous ventricular arrhythmias in 39/96 patients (38%); usually (in 81%) these were unifocal and rare. Patients with ventricular late potentials were older at operation than patients without late potentials (9 (3) v 6 (3) years, P = 0.002). No correlation was found between the presence of ventricular late potentials and the presence or complexity of spontaneous ventricular arrhythmias early after operation. During the mean follow up of 2.5 years no case of sudden death or sustained ventricular tachycardia was found. CONCLUSION--Short-term prognosis after surgical repair of tetralogy of Fallot is good; ventricular late potentials and spontaneous ventricular arrhythmias are often detected shortly after operation, but in the medium term follow up they do not predict sudden death or serious ventricular arrhythmias.

Full text

PDF
580

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Buckingham T. A., Thessen C. C., Stevens L. L., Redd R. M., Kennedy H. L. Effect of conduction defects on the signal-averaged electrocardiographic determination of late potentials. Am J Cardiol. 1988 Jun 1;61(15):1265–1271. doi: 10.1016/0002-9149(88)91167-8. [DOI] [PubMed] [Google Scholar]
  2. Chandar J. S., Wolff G. S., Garson A., Jr, Bell T. J., Beder S. D., Bink-Boelkens M., Byrum C. J., Campbell R. M., Deal B. J., Dick M., 2nd Ventricular arrhythmias in postoperative tetralogy of Fallot. Am J Cardiol. 1990 Mar 1;65(9):655–661. doi: 10.1016/0002-9149(90)91047-a. [DOI] [PubMed] [Google Scholar]
  3. Deanfield J. E., Ho S. Y., Anderson R. H., McKenna W. J., Allwork S. P., Hallidie-Smith K. A. Late sudden death after repair of tetralogy of Fallot: a clinicopathologic study. Circulation. 1983 Mar;67(3):626–631. doi: 10.1161/01.cir.67.3.626. [DOI] [PubMed] [Google Scholar]
  4. Deanfield J. E., McKenna W. J., Hallidie-Smith K. A. Detection of late arrhythmia and conduction disturbance after correction of tetralogy of Fallot. Br Heart J. 1980 Sep;44(3):248–253. doi: 10.1136/hrt.44.3.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Deanfield J. E., McKenna W. J., Presbitero P., England D., Graham G. R., Hallidie-Smith K. Ventricular arrhythmia in unrepaired and repaired tetralogy of Fallot. Relation to age, timing of repair, and haemodynamic status. Br Heart J. 1984 Jul;52(1):77–81. doi: 10.1136/hrt.52.1.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Deanfield J., McKenna W., Rowland E. Local abnormalities of right ventricular depolarization after repair of tetralogy of Fallot: a basis for ventricular arrhythmia. Am J Cardiol. 1985 Feb 15;55(5):522–525. doi: 10.1016/0002-9149(85)90239-5. [DOI] [PubMed] [Google Scholar]
  7. Dunnigan A., Pritzker M. R., Benditt D. G., Benson D. W., Jr Life threatening ventricular tachycardias in late survivors of surgically corrected tetralogy of Fallot. Br Heart J. 1984 Aug;52(2):198–206. doi: 10.1136/hrt.52.2.198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fukushige J., Shimomura K., Harada T., Fukazawa M., Ueda K., Tokunaga K. Incidence and severity of ventricular arrhythmia in patients after repair of tetralogy of Fallot. Jpn Heart J. 1988 Nov;29(6):795–800. doi: 10.1536/ihj.29.795. [DOI] [PubMed] [Google Scholar]
  9. Fuster V., McGoon D. C., Kennedy M. A., Ritter D. G., Kirklin J. W. Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of Fallot. Am J Cardiol. 1980 Oct;46(4):635–642. doi: 10.1016/0002-9149(80)90514-7. [DOI] [PubMed] [Google Scholar]
  10. Garson A., Jr, Randall D. C., Gillette P. C., Smith R. T., Moak J. P., McVey P., McNamara D. G. Prevention of sudden death after repair of tetralogy of Fallot: treatment of ventricular arrhythmias. J Am Coll Cardiol. 1985 Jul;6(1):221–227. doi: 10.1016/s0735-1097(85)80279-5. [DOI] [PubMed] [Google Scholar]
  11. Gillette P. C., Yeoman M. A., Mullins C. E., McNamara D. G. Sudden death after repair of tetralogy of Fallot. Electrocardiographic and electrophysiologic abnormalities. Circulation. 1977 Oct;56(4 Pt 1):566–571. doi: 10.1161/01.cir.56.4.566. [DOI] [PubMed] [Google Scholar]
  12. James F. W., Kaplan S., Chou T. C. Unexpected cardiac arrest in patients after surgical correction of tetralogy of Fallot. Circulation. 1975 Oct;52(4):691–695. doi: 10.1161/01.cir.52.4.691. [DOI] [PubMed] [Google Scholar]
  13. Kavey R. E., Blackman M. S., Sondheimer H. M. Incidence and severity of chronic ventricular dysrhythmias after repair of tetralogy of Fallot. Am Heart J. 1982 Mar;103(3):342–350. doi: 10.1016/0002-8703(82)90272-1. [DOI] [PubMed] [Google Scholar]
  14. Kavey R. E., Thomas F. D., Byrum C. J., Blackman M. S., Sondheimer H. M., Bove E. L. Ventricular arrhythmias and biventricular dysfunction after repair of tetralogy of Fallot. J Am Coll Cardiol. 1984 Jul;4(1):126–131. doi: 10.1016/s0735-1097(84)80329-0. [DOI] [PubMed] [Google Scholar]
  15. Kobayashi J., Hirose H., Nakano S., Matsuda H., Shirakura R., Kawashima Y. Ambulatory electrocardiographic study of the frequency and cause of ventricular arrhythmia after correction of tetralogy of Fallot. Am J Cardiol. 1984 Dec 1;54(10):1310–1313. doi: 10.1016/s0002-9149(84)80088-0. [DOI] [PubMed] [Google Scholar]
  16. Quattlebaum T. G., Varghese J., Neill C. A., Donahoo J. S. Sudden death among postoperative patients with tetralogy of Fallot: a follow-up study of 243 patients for an average of twelve years. Circulation. 1976 Aug;54(2):289–293. doi: 10.1161/01.cir.54.2.289. [DOI] [PubMed] [Google Scholar]
  17. Simson M. B. Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation. 1981 Aug;64(2):235–242. doi: 10.1161/01.cir.64.2.235. [DOI] [PubMed] [Google Scholar]
  18. Stelling J. A., Danford D. A., Kugler J. D., Windle J. R., Cheatham J. P., Gumbiner C. H., Latson L. A., Hofschire P. J. Late potentials and inducible ventricular tachycardia in surgically repaired congenital heart disease. Circulation. 1990 Nov;82(5):1690–1696. doi: 10.1161/01.cir.82.5.1690. [DOI] [PubMed] [Google Scholar]
  19. Sullivan I. D., Presbitero P., Gooch V. M., Aruta E., Deanfield J. E. Is ventricular arrhythmia in repaired tetralogy of Fallot an effect of operation or a consequence of the course of the disease? A prospective study. Br Heart J. 1987 Jul;58(1):40–44. doi: 10.1136/hrt.58.1.40. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Vaksmann G., Fournier A., Davignon A., Ducharme G., Houyel L., Fouron J. C. Frequency and prognosis of arrhythmias after operative "correction" of tetralogy of Fallot. Am J Cardiol. 1990 Aug 1;66(3):346–349. doi: 10.1016/0002-9149(90)90847-t. [DOI] [PubMed] [Google Scholar]
  21. Vaksmann G., el Kohen M., Brevière G. M., Rey C., Francart C., Chammas E., Dupuis C. Incidence et facteurs favorisant les arythmies ventriculaires après réparation de tétralogie de Fallot. Arch Mal Coeur Vaiss. 1990 May;83(5):659–663. [PubMed] [Google Scholar]
  22. Vaksmann G., el Kohen M., Schleich J. M., Kacet S., Rey C., Dupuis C. Influence de l'âge et de la surface corporelle sur le signal moyenné de l'ECG haute amplification après réparation complète des tétralogies de Fallot. Arch Mal Coeur Vaiss. 1992 May;85(5):561–565. [PubMed] [Google Scholar]
  23. Vetter V. L. Sudden death in infants, children, and adolescents. Cardiovasc Clin. 1985;15(3):301–313. [PubMed] [Google Scholar]
  24. Walsh E. P., Rockenmacher S., Keane J. F., Hougen T. J., Lock J. E., Castaneda A. R. Late results in patients with tetralogy of Fallot repaired during infancy. Circulation. 1988 May;77(5):1062–1067. doi: 10.1161/01.cir.77.5.1062. [DOI] [PubMed] [Google Scholar]
  25. Ward D. E., Makinen L., Jones S., Carter S., Shinebourne E. Signal averaged electrocardiography in infants and children with congenital heart disease. Int J Cardiol. 1984 Dec;6(6):699–706. doi: 10.1016/0167-5273(84)90297-3. [DOI] [PubMed] [Google Scholar]
  26. Zimmermann M., Friedli B., Adamec R., Oberhänsli I. Frequency of ventricular late potentials and fractionated right ventricular electrograms after operative repair of tetralogy of Fallot. Am J Cardiol. 1987 Feb 15;59(5):448–453. doi: 10.1016/0002-9149(87)90954-4. [DOI] [PubMed] [Google Scholar]
  27. Zimmermann M., Friedli B., Adamec R., Oberhänsli I. Ventricular late potentials and induced ventricular arrhythmias after surgical repair of tetralogy of Fallot. Am J Cardiol. 1991 Apr 15;67(9):873–878. doi: 10.1016/0002-9149(91)90622-r. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES