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. 1984 Aug;52(2):198–206. doi: 10.1136/hrt.52.2.198

Life threatening ventricular tachycardias in late survivors of surgically corrected tetralogy of Fallot.

A Dunnigan, M R Pritzker, D G Benditt, D W Benson Jr
PMCID: PMC481610  PMID: 6743438

Abstract

Electrophysiological tests were performed in three patients with surgically corrected tetralogy of Fallot (mean age at evaluation 25 years, mean age at surgical correction 4 years) who had had either a cardiac arrest or transient neurological disturbances (presyncope, syncope) associated with ventricular arrhythmias. All three patients had an excellent haemodynamic result from surgery as judged by echocardiography and cardiac catheterisation. Ambulatory electrocardiographic monitoring and stress exercise testing were normal in two patients and showed complex ventricular ectopy in one. During invasive electrophysiological evaluation all three patients had inducible ventricular tachycardia (monomorphic QRS in two patients, cycle lengths 230 and 240 ms; polymorphic QRS in one patient, mean cycle length 200 ms) with adverse haemodynamic effects in all three patients. These findings suggest that rapid ventricular tachycardia with detrimental haemodynamic consequences, similar to that induced during laboratory study, was the basis for the presenting symptoms in each patient. This possibility was confirmed in one patient who had identical QRS morphology during both spontaneous ventricular tachycardia and that induced during the laboratory study. Thus sudden death or symptoms of syncope postoperatively in patients with surgically corrected tetralogy of Fallot appear to be due to rapid ventricular tachycardia, which may occur despite an apparently excellent surgical result.

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Selected References

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

  1. Bacaner M. B., Benditt D. G. Antiarrhythmic, antifibrillatory, and hemodynamic actions of bethanidine sulfate: an orally effective analog of bretylium for suppression of ventricular tachyarrhythmias. Am J Cardiol. 1982 Oct;50(4):728–734. doi: 10.1016/0002-9149(82)91226-7. [DOI] [PubMed] [Google Scholar]
  2. Benditt D. G., Benson D. W., Jr, Klein G. J., Pritzker M. R., Kriett J. M., Anderson R. W. Prevention of recurrent sudden cardiac arrest: role of provocative electropharmacologic testing. J Am Coll Cardiol. 1983 Sep;2(3):418–425. doi: 10.1016/s0735-1097(83)80267-8. [DOI] [PubMed] [Google Scholar]
  3. Benditt D. G., Pritchett L. C., Smith W. M., Wallace A. G., Gallagher J. J. Characteristics of atrioventricular conduction and the spectrum of arrhythmias in lown-ganong-levine syndrome. Circulation. 1978 Mar;57(3):454–465. doi: 10.1161/01.cir.57.3.454. [DOI] [PubMed] [Google Scholar]
  4. Benson D. W., Jr, Benditt D. G., Anderson R. W., Dunnigan A., Pritzker M. R., Kulik T. J., Zavoral J. H. Cardiac arrest in young, ostensibly healthy patients: clinical, hemodynamic, and electrophysiologic findings. Am J Cardiol. 1983 Jul;52(1):65–69. doi: 10.1016/0002-9149(83)90070-x. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. 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]
  7. 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]
  8. Garson A., Jr, Gillette P. C., Gutgesell H. P., McNamara D. G. Stress-induced ventricular arrhythmia after repair of tetralogy of Fallot. Am J Cardiol. 1980 Dec 1;46(6):1006–1012. doi: 10.1016/0002-9149(80)90359-8. [DOI] [PubMed] [Google Scholar]
  9. Garson A., Jr, Nihill M. R., McNamara D. G., Cooley D. A. Status of the adult and adolescent after repair of tetralogy of Fallot. Circulation. 1979 Jun;59(6):1232–1240. doi: 10.1161/01.cir.59.6.1232. [DOI] [PubMed] [Google Scholar]
  10. Garson A., Jr, Porter C. B., Gillette P. C., McNamara D. G. Induction of ventricular tachycardia during electrophysiologic study after repair of tetralogy of Fallot. J Am Coll Cardiol. 1983 Jun;1(6):1493–1502. doi: 10.1016/s0735-1097(83)80054-0. [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. Horowitz L. N., Vetter V. L., Harken A. H., Josephson M. E. Electrophysiologic characteristics of sustained ventricular tachycardia occurring after repair of tetralogy of fallot. Am J Cardiol. 1980 Sep;46(3):446–452. doi: 10.1016/0002-9149(80)90014-4. [DOI] [PubMed] [Google Scholar]
  13. 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]
  14. Josephson M. E., Horowitz L. N., Farshidi A., Spielman S. R., Michelson E. L., Greenspan A. M. Recurrent sustained ventricular tachycardia. 4. Pleomorphism. Circulation. 1979 Mar;59(3):459–468. doi: 10.1161/01.cir.59.3.459. [DOI] [PubMed] [Google Scholar]
  15. Katz N. M., Blackstone E. H., Kirklin J. W., Pacifico A. D., Bargeron L. M., Jr Late survival and symptoms after repair of tetralogy of Fallot. Circulation. 1982 Feb;65(2):403–410. doi: 10.1161/01.cir.65.2.403. [DOI] [PubMed] [Google Scholar]
  16. Kugler J. D., Pinsky W. W., Cheatham J. P., Hofschire P. J., Mooring P. K., Fleming W. H. Sustained ventricular tachycardia after repair of tetralogy of Fallot: new electrophysiologic findings. Am J Cardiol. 1983 Apr;51(7):1137–1143. doi: 10.1016/0002-9149(83)90359-4. [DOI] [PubMed] [Google Scholar]
  17. Ruskin J. N., DiMarco J. P., Garan H. Out-of-hospital cardiac arrest: electrophysiologic observations and selection of long-term antiarrhythmic therapy. N Engl J Med. 1980 Sep 11;303(11):607–613. doi: 10.1056/NEJM198009113031103. [DOI] [PubMed] [Google Scholar]
  18. Tamer D., Wolff G. S., Ferrer P., Pickoff A. S., Casta A., Mehta A. V., Garcia O., Gelband H. Hemodynamics and intracardiac conduction after operative repair of tetralogy of Fallot. Am J Cardiol. 1983 Feb;51(3):552–556. doi: 10.1016/s0002-9149(83)80095-2. [DOI] [PubMed] [Google Scholar]
  19. Vetter V. L., Horowitz L. N. Electrophysiologic residua and sequelae of surgery for congenital heart defects. Am J Cardiol. 1982 Sep;50(3):588–604. doi: 10.1016/0002-9149(82)90328-9. [DOI] [PubMed] [Google Scholar]
  20. Vick G. W., 3rd, Serwer G. A. Echocardiographic evaluation of the postoperative tetralogy of Fallot patient. Circulation. 1978 Nov;58(5):842–849. doi: 10.1161/01.cir.58.5.842. [DOI] [PubMed] [Google Scholar]
  21. Wessel H. U., Bastanier C. K., Paul M. H., Berry T. E., Cole R. B., Muster A. J. Prognostic significance of arrhythmia in tetralogy of Fallot after intracardiac repair. Am J Cardiol. 1980 Nov;46(5):843–848. doi: 10.1016/0002-9149(80)90438-5. [DOI] [PubMed] [Google Scholar]
  22. Wolff G. S., Rowland T. W., Ellison R. C. Surgically induced right bundle-branch block with left anterior hemiblock. An ominous sign in postoperative tetralogy of Fallot. Circulation. 1972 Sep;46(3):587–594. doi: 10.1161/01.cir.46.3.587. [DOI] [PubMed] [Google Scholar]

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