CLINICAL STUDY: CONGENITAL HEART DISEASE
Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of fallot
Akash Ghai, MD* ,
Candice Silversides, MD* ,
Louise Harris, MD, FACC*,
Gary D. Webb, MD, FACC*,
Samuel C. Siu, MD, SM, FACC* and
Judith Therrien, MD, FACC*,*
* Toronto Congenital Cardiac Centre for Adults, Toronto, Ontario, Canada
Echocardiographic Laboratory, Toronto, Ontario, Canada
Toronto General Hospital, Heart and Stroke Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada
Manuscript received March 14, 2002;
revised manuscript received May 24, 2002,
accepted June 19, 2002.
* Reprint requests and correspondence: Dr. Judith Therrien, Toronto General Hospital, 200 Elizabeth Street, 12EN 213, Toronto, Ontario, Canada M5G 2C4.
judith.therrien{at}uhn.on.ca
OBJECTIVES: The purpose of this study was to determine if left ventricular (LV) systolic dysfunction was also a predictor of sudden cardiac death (SCD) in adults late after repair of tetralogy of Fallot (TOF).
BACKGROUND: Previous studies looking at risk factors for SCD in adults with repair of TOF have focused on the right ventricle (RV).
METHODS: A retrospective chart review of patients assessed at the Toronto Congenital Cardiac Centre for Adults was performed. Twelve adult patients with repaired TOF and SCD were identified (SCD group). A total of 125 living adult patients with repaired TOF were randomly selected for comparison (control group).
RESULTS: Patients with SCD were more likely to exhibit moderate or severe pulmonary regurgitation (92% vs. 51%, p = 0.02), have a history of sustained ventricular tachycardia (42% vs. 6%, p < 0.01), and have a QRS  180 ms (56% vs. 13%, p = 0.02). Moderate or severe LV systolic dysfunction was also significantly more common in patients with SCD than in the control group (42% vs. 9%, p < 0.01) with a positive predictive value of 29%. The combination of moderate or severe LV systolic dysfunction and QRS 180 ms had a positive and negative predictive value for SCD of 66% and 93%, respectively.
CONCLUSIONS: Moderate or severe LV systolic dysfunction is significantly more common in adult patients with repaired TOF and SCD. The combination of QRS 180 ms and significant LV systolic dysfunction has high positive and negative predictive value for SCD. The implication of the role of prophylactic antiarrhythmic implantable cardiac defibrillator insertion in these patients needs further elucidating.
|
Abbreviations and Acronyms
| | EF | | ejection fraction | | LV | | left ventricle or left ventricular | | NYHA | | New York Heart Association | | PR | | pulmonary regurgitation | | RV | | right ventricle or right ventricular | | SCD | | sudden cardiac death | | TCCCA | | Toronto Congenital Cardiac Centre for Adults | | TOF | | tetralogy of Fallot | | VT | | ventricular tachycardia |
|
This article has been cited by other articles:
|
|
|
|
 
P. Lurz, R. Puranik, J. Nordmeyer, V. Muthurangu, M. S. Hansen, S. Schievano, J. Marek, P. Bonhoeffer, and A. M. Taylor
Improvement in left ventricular filling properties after relief of right ventricle to pulmonary artery conduit obstruction: contribution of septal motion and interventricular mechanical delay
Eur. Heart J.,
September 2, 2009;
30(18):
2266 - 2274.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Petit, M. J. Gillespie, M. A. Harris, T. L. Seymour, T. Y. Liu, A. Khan, J. W. Gaynor, and J. J. Rome
Relief of branch pulmonary artery stenosis reduces pulmonary valve insufficiency in a swine model.
J. Thorac. Cardiovasc. Surg.,
August 1, 2009;
138(2):
382 - 389.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
December 2, 2008;
52(23):
e143 - e263.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
December 2, 2008;
118(23):
e714 - e833.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Silka and Y. Bar-Cohen
Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?: Patients With Congenital Heart Disease and a Systemic Ventricular Ejection Fraction Less Than 30% Should Undergo Prophylactic Implantation of an Implantable Cardioverter Defibrillator
Circ Arrhythm Electrophysiol,
October 1, 2008;
1(4):
298 - 306.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Triedman
Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?: Implantable Cardioverter Defibrillator Implantation Guidelines Based Solely on Left Ventricular Ejection Fraction Do Not Apply to Adults With Congenital Heart Disease
Circ Arrhythm Electrophysiol,
October 1, 2008;
1(4):
307 - 316.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. K. Witte, C. B. Pepper, J. C. Cowan, J. D. Thomson, K. M. English, and M. E. Blackburn
Implantable cardioverter-defibrillator therapy in adult patients with tetralogy of Fallot
Europace,
August 1, 2008;
10(8):
926 - 930.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
e1 - e62.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
Circulation,
May 27, 2008;
117(21):
e350 - e408.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Sommer, Z. M. Hijazi, and J. F. Rhodes
Pathophysiology of Congenital Heart Disease in the Adult: Part III: Complex Congenital Heart Disease
Circulation,
March 11, 2008;
117(10):
1340 - 1350.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Bedard, D. F. Shore, and M. A. Gatzoulis
Adult congenital heart disease: a 2008 overview
Br. Med. Bull.,
March 1, 2008;
85(1):
151 - 180.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A L Knauth, K Gauvreau, A J Powell, M J Landzberg, E P Walsh, J E Lock, P J d. Nido, and T Geva
Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair
Heart,
February 1, 2008;
94(2):
211 - 216.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Khairy, L. Harris, M. J. Landzberg, S. Viswanathan, A. Barlow, M. A. Gatzoulis, S. M. Fernandes, L. Beauchesne, J. Therrien, P. Chetaille, et al.
Implantable Cardioverter-Defibrillators in Tetralogy of Fallot
Circulation,
January 22, 2008;
117(3):
363 - 370.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S.-C. Yap, J. W. Roos-Hesselink, E. S. Hoendermis, W. Budts, H. W. Vliegen, B. J.M. Mulder, A. P.J. van Dijk, M. J. Schalij, and W. Drenthen
Outcome of implantable cardioverter defibrillators in adults with congenital heart disease: a multi-centre study
Eur. Heart J.,
August 1, 2007;
28(15):
1854 - 1861.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Coats, S. Khambadkone, G. Derrick, M. Hughes, R. Jones, B. Mist, D. Pellerin, J. Marek, J. E. Deanfield, P. Bonhoeffer, et al.
Physiological consequences of percutaneous pulmonary valve implantation: the different behaviour of volume- and pressure-overloaded ventricles
Eur. Heart J.,
August 1, 2007;
28(15):
1886 - 1893.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. R Chaturvedi and A. N Redington
Pulmonary regurgitation in congenital heart disease
Heart,
July 1, 2007;
93(7):
880 - 889.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. M. Bashore
Adult Congenital Heart Disease: Right Ventricular Outflow Tract Lesions
Circulation,
April 10, 2007;
115(14):
1933 - 1947.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. P. Walsh and F. Cecchin
Arrhythmias in Adult Patients With Congenital Heart Disease
Circulation,
January 30, 2007;
115(4):
534 - 545.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
e247 - e346.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
746 - 837.
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. K. Chowdhury, S. Sathia, R. Ray, R. Singh, K. K. Pradeep, and P. Venugopal
Histopathology of the right ventricular outflow tract and its relationship to clinical outcomes and arrhythmias in patients with tetralogy of Fallot.
J. Thorac. Cardiovasc. Surg.,
August 1, 2006;
132(2):
270 - 277.e4.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Karamlou, I. Silber, R. Lao, B. W. McCrindle, L. Harris, E. Downar, G. D. Webb, J. M. Colman, G. S. Van Arsdell, and W. G. Williams
Outcomes after late reoperation in patients with repaired tetralogy of fallot: the impact of arrhythmia and arrhythmia surgery.
Ann. Thorac. Surg.,
May 1, 2006;
81(5):
1786 - 1793.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Kirsh, E. A. Stephenson, and A. N. Redington
Recovery of Left Ventricular Systolic Function After Biventricular Resynchronization Pacing in a Child With Repaired Tetralogy of Fallot and Severe Biventricular Dysfunction
Circulation,
April 11, 2006;
113(14):
e691 - e692.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. G. Williams, G. D. Pearson, R. J. Barst, J. S. Child, P. del Nido, W. M. Gersony, K. S. Kuehl, M. J. Landzberg, M. Myerson, S. R. Neish, et al.
Report of the National Heart, Lung, and Blood Institute Working Group on Research in Adult Congenital Heart Disease
J. Am. Coll. Cardiol.,
February 21, 2006;
47(4):
701 - 707.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. V. Babu-Narayan, P. J. Kilner, W. Li, J. C. Moon, O. Goktekin, P. A. Davlouros, M. Khan, S. Y. Ho, D. J. Pennell, and M. A. Gatzoulis
Ventricular Fibrosis Suggested by Cardiovascular Magnetic Resonance in Adults With Repaired Tetralogy of Fallot and Its Relationship to Adverse Markers of Clinical Outcome
Circulation,
January 24, 2006;
113(3):
405 - 413.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Y. Abd El Rahman, W. Hui, M. Yigitbasi, F. Dsebissowa, S. Schubert, R. Hetzer, P. E. Lange, and H. Abdul-Khaliq
Detection of left ventricular asynchrony in patients with right bundle branch block after repair of tetralogy of Fallot using tissue-Doppler imaging-derived strain
J. Am. Coll. Cardiol.,
March 15, 2005;
45(6):
915 - 921.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Frigiola, A.N. Redington, S. Cullen, and M. Vogel
Pulmonary Regurgitation Is an Important Determinant of Right Ventricular Contractile Dysfunction in Patients With Surgically Repaired Tetralogy of Fallot
Circulation,
September 14, 2004;
110(11_suppl_1):
II-153 - II-157.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Geva, B. M. Sandweiss, K. Gauvreau, J. E. Lock, and A. J. Powell
Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging
J. Am. Coll. Cardiol.,
March 17, 2004;
43(6):
1068 - 1074.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
