Prevention of sudden death after repair of tetralogy of fallot: Treatment of ventricular arrhythmias

• Published in: Journal of the American College of Cardiology 1985-07, Vol.6 (1), p.221-227
• Main Authors: Garson, Arthur, Randall, David C., GilletteD, Paul C., Smith, Richard T., Moak, Jeffrey P., McVey, Pat, McNamara, Dan G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Anti-Arrhythmia Agents - therapeutic use; Antiarythmic agents; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - mortality; Arrhythmias, Cardiac - prevention & control; Biological and medical sciences; Blood Pressure; Cardiovascular system; Child; Child, Preschool; Follow-Up Studies; Heart Block - etiology; Heart Ventricles; Hemodynamics; Humans; Infant; Medical sciences; Pharmacology. Drug treatments; Postoperative Complications; Risk; Tetralogy of Fallot - complications; Tetralogy of Fallot - surgery; Time Factors
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(85)80279-5

The majority of sudden deaths after repair of tetralogy of Fallot have been presumed to be due to ventricular arrhythmia; however, it remains to be demonstrated that antiarrhythmic medication reduces the incidence of sudden death. Since 1978, ventricular arrhythmias have been treated aggressively; these include any ventricular arrhythmia on routine electrocardiogram and more than 10 uniform premature ventricular complexes per hour on 24 hour electrocardiogram. A review was undertaken of 488 patients followed up for more than 1 month after repair of tetralogy of Fallot (mean follow-up time 6.1 gears); 13.5% had ventricular arrhythmia on routine electrocardiogram. Ventricular arrhythmia appeared from 2 months to 21 years postoperatively (mean 7.3 g ears). Ventricular arrhythmias were significantly (p < 0.01) related to: longer follow-up duration, older age at follow-up, older age at operation and higher postoperative right ventricular systolic and end-diastolic pressures. Ventricular arrhythmia on routine electrocardiogram occurred in 100% of those who later died suddenly compared with 12% of those who did not die (p < 0.01). Treatment for ventricular arrhythmia was given to 46 patients and considered “successful” if there were fewer than 10 uniform premature ventricular complexes per hour on 24 hour electrocardiogram. A successful drug was found in 44 of the 46: 30 of 34 given phenytoin, 6 of 9 given propranolol, 1 of 7 given quinidine, 1 of 2 given disopyramide, 8 of 9 given mexiletine and 4 of 5 given amiodarone. Sudden death did not occur in any of the 44 patients with successful antiarrhythmic treatment compared with a 39% incidence of sudden deaths in those with ventricular arrhythmias who were untreated (7 of 21) or had unsuccessful antiarrhythmic treatment (2 of 2) (p < 0.01). In conclusion, with aggressive antiarrhythmic treatment of ventricular arrhythmias, sudden death in postoperative tetralogy of Fallot has been significantly reduced.