Electrophysiological study prior to planned pulmonary valve replacement in patients with repaired tetralogy of Fallot.

Autor: Bouyer B; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Jalal Z; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.; Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France., Daniel Ramirez F; University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Derval N; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Iriart X; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.; Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France., Duchateau J; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Roubertie F; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.; Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France., Tafer N; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.; Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France., Tixier R; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Pambrun T; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Cheniti G; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Ascione C; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Yokoyama M; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Kowalewski C; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Buliard S; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Chauvel R; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Arnaud M; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Hocini M; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Haïssaguerre M; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Jaïs P; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France., Cochet H; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.; Department of Radiology, Bordeaux University Hospital (CHU), Bordeaux, France., Thambo JB; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.; Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France., Sacher F; Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France.; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2023 Jun; Vol. 34 (6), pp. 1395-1404. Date of Electronic Publication: 2023 May 26.
DOI: 10.1111/jce.15940
Abstrakt: Aim: Ventricular arrhythmias (VAs) are the most common cause of death in patients with repaired Tetralogy of Fallot (rTOF). However, risk stratifying remains challenging. We examined outcomes following programmed ventricular stimulation (PVS) with or without subsequent ablation in patients with rTOF planned for pulmonary valve replacement (PVR).
Methods: We included all consecutive patients with rTOF referred to our institution from 2010 to 2018 aged ≥18 years for PVR. Right ventricular (RV) voltage maps were acquired and PVS was performed from two different sites at baseline, and if non-inducible under isoproterenol. Catheter and/or surgical ablation was performed when patients were inducible or when slow conduction was present in anatomical isthmuses (AIs). Postablation PVS was undertaken to guide implantable cardioverter-defibrillator (ICD) implantation.
Results: Seventy-seven patients (36.2 ± 14.3 years old, 71% male) were included. Eighteen were inducible. In 28 patients (17 inducible, 11 non-inducible but with slow conduction) ablation was performed. Five had catheter ablation, surgical cryoablation in 9, both techniques in 14. ICDs were implanted in five patients. During a follow-up of 74 ± 40 months, no sudden cardiac death occurred. Three patients experienced sustained VAs, all were inducible during the initial EP study. Two of them had an ICD (low ejection fraction for one and important risk factor for arrhythmia for the second). No VAs were reported in the non-inducible group (p < .001).
Conclusion: Preoperative EPS can help identifying patients with rTOF at risk for VAs, providing an opportunity for targeted ablation and may improve decision-making regarding ICD implantation.
(© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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