Arrhythmia risk stratification late after Tetralogy of Fallot repair with pulmonary regurgitation.

Among the most feared sequelae of repaired Tetralogy of Fallot (TOF) are ventricular arrhythmias and sudden cardiac death (SCD) [1]. The presence of pulmonary regurgitation as a potential risk factor for arrhythmias has sparked interest in a more aggressive strategy for reoperation in TOF patients and chronic pulmonary regurgitation. Although this strategy was initially suggested to be protective against the development of ventricular arrhythmias, timely pulmonary valve replacement (PVR) alone, does not appear to abort the SCD risk as myocardial fibrosis, a clear arrhythmic substrate remains. In this case, we present arrhythmia risk stratification and management of a patient with repaired ToF and concomitant pulmonary regurgitation.