Late Arrhythmias: Current Approaches

  • Sara ForestiEmail author
  • Maria Cristina Tavera
  • Pierpaolo Lupo
  • Riccardo Cappato


ToF represents a good example of the many challenges in treating patients with adult congenital heart disease (ACHD). This abnormality is not infrequent, being the most common form of cyanotic congenital heart disease (CHD) after 1 year of age with an incidence of about 10% of all CHD [2]. Surgery for correction of the anatomic and hemodynamic imbalance associated with ToF was first introduced in the mid fifties and became common practice in the sixties. Continuous improvements in surgical therapy have led to a relatively large population of adult patients with ToF reaching the age of 40 to 50 years in good clinical condition and with an extended life expectancy. Despite these improvements, a significant proportion of ToF patients still present with a higher morbidity and mortality compared to the general population [3].


Congenital Heart Disease Sudden Death Ventricular Tachycardia Ventricular Arrhythmia Right Ventricle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Walsh EP, Cecchin F (2007) Arrhythmias in adult patients with congenital heart disease. Circulation 115:434–545CrossRefGoogle Scholar
  2. 2.
    . The Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology. ESC Guidelines for the management of grown-up congenital Heart Disease (new version 2010)Google Scholar
  3. 3.
    Murphy JG, Gersh BJ, Mair DD et al (1993) Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 329:593–599PubMedCrossRefGoogle Scholar
  4. 4.
    Gatzoulis MA, Belaji S, Webber SA et al (2000) Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 356:875–881CrossRefGoogle Scholar
  5. 5.
    Nollert G, Fischlein T, Bouterwek S et al (1997) Long term survival in patients with repair of tetralogy of Fallot: 36 year follow up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 30:1374–1383PubMedCrossRefGoogle Scholar
  6. 6.
    Bouchardy J, Therrien J, Pilote L et al (2009) Atrial arrhythmias in adults with congenital heart disease. Circulation 120:1679–1686PubMedCrossRefGoogle Scholar
  7. 7.
    Khairy P, Aboulhosn J, Gurvizet MZ et al (2010) Arrhythmia burden in adults with surgically repaired tetralogy of Fallot. A multi-institutional study. Circulation 122:868–875PubMedCrossRefGoogle Scholar
  8. 8.
    Silka MJ, Hardy BG, Menashe VD et al (1998) A population based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol 32:245–251PubMedCrossRefGoogle Scholar
  9. 9.
    Friedly B, Bolens M, Taktak M et al (1988) Conduction disturbances after correction of tetralogy of Fallot: are electrophysiologic studies of prognostic value? Am Coll Cardiol 11:162–165CrossRefGoogle Scholar
  10. 10.
    Chandar JS, Wolff GS, Garson EP (1990) Ventricular arrhythmias in post-operative tetralogy of Fallot. Am J Cardiol 65:655–661PubMedCrossRefGoogle Scholar
  11. 11.
    Garson A, Randall DC, Gillette PC et al (1985) Prevention of sudden death after repair of tetralogy of Fallot: treatment of ventricular arrhythmias. J Am Coll Cardiol 6:221–227PubMedCrossRefGoogle Scholar
  12. 12.
    Zahka KG, Horneffer PJ, Rowe SA et al (1988) Long-term valvular function after total repair of tetralogy of Fallot. Relation to ventricular arrhythmias. Circulation 78(Suppl 5):III14–19PubMedGoogle Scholar
  13. 13.
    Gatzoulis MA, Till JA, Somerville J et al (1995) Mechanoelectrical interaction in tetralogy of Fallot. Circulation 92:231–237PubMedCrossRefGoogle Scholar
  14. 14.
    Khairy P, Landzberg MJ, Gatzoulis MA et al (2004) Value of programmed ventricular stimulation after tetralogy of Fallot repair: a multicenter study. Circulation 109:1994–2000PubMedCrossRefGoogle Scholar
  15. 15.
    Cullen S, Celermajer DS, Franklin R et al (1994) Prognostic significance of ventricular arrhythmia after repair of tetralogy of Fallot: a 12 years prospective study. J Am Coll Cardiol 23:1151–1155PubMedCrossRefGoogle Scholar
  16. 16.
    Hamada H, Terai M, Jibiki T et al (2002) Influence of early repair of tetralogy of Fallot without an outflow patch on late arrhythmias and sudden death: a 27 year follow-up study following a uniform surgical approach. Cardiol Young 12:345–351PubMedCrossRefGoogle Scholar
  17. 17.
    Khairy P, Harris L, Lanzberg MJ et al (2008) Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation 117:363–370PubMedCrossRefGoogle Scholar
  18. 18.
    Alexander ME, Walsh EP, Saul JP et al (1999) Value of programmed ventricular stimulation in patients with congenital heart disease. J Cardiovasc Electrophysiol 10:1033–1044PubMedCrossRefGoogle Scholar
  19. 19.
    Dore A, Santagata P, Dubucet M et al (2004) Implantable cardioverter defibrillators in adults with congenital heart disease. A single center experience. PACE 27:47–51PubMedCrossRefGoogle Scholar
  20. 20.
    Fortescue EB, Berul CI, Cecchin F et al (2004) Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm 1:150–159PubMedCrossRefGoogle Scholar
  21. 21.
    Bardy GH, Smith WM, Hood MA et al (2010) An entirely subcutaneus implantable cardioverter-defibrillator. N Engl J Med 363:36–44PubMedCrossRefGoogle Scholar
  22. 22.
    Gonska BD, Cao K, Raab J et al (1996) Radiofrequency catheter ablation of right ventricular tachycardia late after repair of congenital heart defects. Circulation 94:1902–1908PubMedCrossRefGoogle Scholar
  23. 23.
    Furushima H, Chinushi M, Sugiura H et al (2006) Ventricular tachycardia late after repair of congenital heart disease: efficacy of combination therapy with radiofrequency catheter ablation and class III antiarrhythmic agents and long term out come. J Electrocardiol 39:219–224PubMedCrossRefGoogle Scholar
  24. 24.
    Rostok T, Willems S, Venura R et al (2004) Radiofrequency catheter ablation of a macroreentrant ventricular tachycardia late after surgical repair of tetralogy of Fallot using the electroanatomical mapping. PACE 27:801–804CrossRefGoogle Scholar
  25. 25.
    Zeppenfeld K, Schalji MJ, Bartelings MM et al (2007) Catheter ablation of ventricular tachycardia after repair of congenital heart disease. Electroanatomic identification of the critical right ventricular isthmus. Circulation 116:2241–2252PubMedCrossRefGoogle Scholar
  26. 26.
    Thierrien J, Siu SC, Harris L et al (2001) Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 103:2489–2494CrossRefGoogle Scholar
  27. 27.
    Harrild DM, Berul CI, Cecchi F et al (2009) Pulmonary valve replacement in tetralogy of Fallot. Impact on survival and ventricular tachycardia. Circulation 119:445–451PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Sara Foresti
    • 1
    Email author
  • Maria Cristina Tavera
  • Pierpaolo Lupo
  • Riccardo Cappato
  1. 1.Arrhythmia and Electrophysiology CenterIRCCS Policlinico San DonatoSan Donato Milanese (Mi)Italy

Personalised recommendations