Division of Cardiology, University of Colorado, Aurora, Colorado.
Division of Cardiology, University of Colorado, Aurora, Colorado; Division of Cardiology, Children's Hospital of Colorado, Aurora, Colorado.
Heart Rhythm. 2018 May;15(5):679-685. doi: 10.1016/j.hrthm.2018.01.020. Epub 2018 Jan 9.
Ventricular tachyarrhythmias are the most common cause of death in patients with repaired tetralogy of Fallot (TOF), but predicting those at risk remains a challenge. An electrophysiology study (EPS) has been proposed to risk stratify patients with TOF.
We sought to evaluate a perioperative EPS-guided approach to risk stratify patients with TOF undergoing pulmonary valve replacement (PVR) and guide concomitant cryoablation.
A prospective cohort study of patients with TOF undergoing an EPS at the time of PVR from 2006 to 2017 was conducted at 2 centers. Patients inducible at the time of pre-PVR had undergone concomitant cryoablation in addition to PVR. A repeat post-PVR EPS was performed in those initially inducible to guide implantable cardioverter-defibrillator (ICD) implantation.
Of 70 patients who underwent a pre-PVR EPS, 34 (49%) had inducible sustained ventricular tachycardia (VT): 25 monomorphic VT and 9 polymorphic VT. Among patients undergoing cryoablation, 14 (45%) had inducible VT and underwent ICD implantation. During a mean follow-up period of 6.1 ± 3.2 years, 3 patients (21%) had appropriate ICD shocks for symptomatic VT. There was an average of 2.3 shocks (range 1-4 shocks), and the mean time to first shock post-device implantation was 3.6 years (range 2.9-4.3 years). Among patients with negative pre- or post-PVR EPS results, 2 had VT requiring radiofrequency ablation and/or subsequent ICD implantation. There were no arrhythmic deaths.
A pre-PVR EPS identified patients with higher-risk TOF undergoing PVR. Despite empirical VT cryoablation at the time of PVR, a high percentage of patients remained inducible for VT. In this high-risk cohort, post-PVR EPS evaluation is important to identify patients at risk of VT despite cryoablation.
室性心动过速是法洛四联症（TOF）修复患者死亡的最常见原因，但预测风险仍然是一个挑战。已经提出电生理研究（EPS）来对 TOF 患者进行风险分层。
我们旨在评估 TOF 患者在接受肺动脉瓣置换术（PVR）时进行围手术期 EPS 指导的风险分层方法，并指导同时进行冷冻消融。
对 2006 年至 2017 年期间在 2 个中心接受 PVR 时进行 EPS 的 TOF 患者进行前瞻性队列研究。在 PVR 前有可诱发性的患者除了 PVR 外还进行了同时冷冻消融。在最初可诱发性的患者中进行了 PVR 后重复 EPS，以指导植入式心脏复律除颤器（ICD）的植入。
在 70 名接受 PVR 前 EPS 的患者中，有 34 名（49%）有可诱发性持续性室性心动过速（VT）：25 名单形性 VT 和 9 名多形性 VT。在接受冷冻消融的患者中，有 14 名（45%）有可诱发性 VT，并进行了 ICD 植入。在平均 6.1±3.2 年的随访期间，有 3 名（21%）患者因有症状的 VT 而发生了适当的 ICD 电击。平均有 2.3 次电击（范围 1-4 次电击），自装置植入后首次电击的平均时间为 3.6 年（范围 2.9-4.3 年）。在 PVR 前或后 EPS 结果为阴性的患者中，有 2 名患者因 VT 需要射频消融和/或随后的 ICD 植入。没有心律失常死亡。
PVR 前的 EPS 识别出了行 PVR 的高危 TOF 患者。尽管在 PVR 时进行了经验性 VT 冷冻消融，但仍有很大比例的患者对 VT 有可诱发性。在这个高危患者中，尽管进行了冷冻消融，PVR 后 EPS 评估对识别有 VT 风险的患者很重要。
