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Risk of cardiac tachyarrhythmia in patients with repaired tetralogy of Fallot: a multicenter cardiac MRI based study

  • Niek E. G. BeurskensEmail author
  • Quint A. J. Hagdorn
  • Thomas M. Gorter
  • Rolf M. F. Berger
  • Karin M. Vermeulen
  • Joost P. van Melle
  • Tjark E. Ebels
  • George K. Lui
  • Scott R. Ceresnak
  • Frandics P. Chan
  • Tineke P. Willems
Original Paper

Abstract

Cardiac tachyarrhythmias are the leading cause of morbidity and mortality in patients with repaired tetralogy of Fallot (TOF). We evaluated risk factors for sustained ventricular tachyarrhythmia (VT) and atrial tachyarrhythmia (ATA) in these patients. Patients (n = 319) who underwent cardiac magnetic resonance (CMR) imaging at two tertiary centers between 2007 and 2016 were assessed. Potential risk markers, based on history, cardiac magnetic resonance imaging (CMR), electrocardiography (ECG) and echocardiography, were analyzed for prediction of the primary endpoint of VT, and the secondary endpoint of ATA. During a follow-up of 3.5 (0.9–6.1) years, 20 (6.3%) patients reached the primary endpoint, and 30 (9.4%) the secondary endpoint. Multivariable cox hazards regression identified right ventricular (RV) end-diastolic volume (Hazard ratio [HR] 2.03, per 10 ml/m2 increase; p = 0.02), RV end-systolic volume (HR 3.04, per 10 ml/m2 increase; p = 0.04), RV mass (HR 1.88, per 10 g/m2 increase; p = 0.02), and RV ejection fraction (HR 6.06, per 10% decrease; p = 0.02) derived from CMR to be independent risk factors of VT. In addition, QRS-duration (HR 1.70, per 10 ms increase; p = 0.001) and body mass index (BMI: HR 1.8, per 5 kg/m2 increase; p = 0.02) were independent markers of VT. Older age at TOF repair (HR 1.33, per 2 months increase; p = 0.03) and BMI (HR 1.76, per 5 kg/m2 increase; p < 0.001) independently predicted ATA. RV systolic dysfunction, hypertrophy and dilatation on CMR, together with QRS prolongation, and obesity are predictive of VT in TOF patients. Older age at TOF repair and obesity were associated with the occurrence of ATA.

Keywords

Tetralogy of Fallot Cardiac magnetic resonance imaging Cardiac tachyarrhythmia Risk stratification ICD implantation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Niek E. G. Beurskens
    • 1
    Email author
  • Quint A. J. Hagdorn
    • 2
  • Thomas M. Gorter
    • 1
  • Rolf M. F. Berger
    • 2
  • Karin M. Vermeulen
    • 3
  • Joost P. van Melle
    • 1
  • Tjark E. Ebels
    • 4
  • George K. Lui
    • 5
  • Scott R. Ceresnak
    • 6
  • Frandics P. Chan
    • 7
  • Tineke P. Willems
    • 8
  1. 1.Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  2. 2.Center for Congenital Heart Diseases, Beatrix Children’s Hospital, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  3. 3.Department of Epidemiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  4. 4.Department of Cardiothoracic Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  5. 5.Departments of Medicine and Pediatrics, Divisions of Cardiovascular Medicine and Pediatric CardiologyStanford University School of MedicinePalo AltoUSA
  6. 6.Division of Pediatric CardiologyStanford University School of MedicinePalo AltoUSA
  7. 7.Department of Radiology, Stanford University Medical CenterStanford University School of MedicinePalo AltoUSA
  8. 8.Department of Radiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands

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