Pediatric/Adult Congenital Heart Disease -> Adult Congenital Heart Disease D-AB31 - ACHD and Pediatric EP (ID 29) Abstract

D-AB31-06 - The Impact Of Late Pulmonic Valve Replacement On Ventricular Arrhythmias Associated With Tetralogy Of Fallot In Adults A Meta-analysis And Metaregression (ID 778)

 Y. Khalid: Nothing relevant to disclose.


Background: For survivors of Tetralogy of Fallot following repair, arrhythmias are a known complication, especially atrial fibrillation. However, there is no consensus yet on when exactly there should be pulmonary valve replacement (PVR) for patients with Tetralogy of Fallot as well as the impact of PVR on the subsequent development of fatal arrhythmias such as ventricular tachycardias.
Objective: Our clinical hypothesis is that even with late PVR many years after initial Tetralogy of Fallot repair, the incidence of ventricular arrhythmias will be much lower compared to patients who never have PVR.
Methods: We performed aggregate data meta-analyses on 9 studies with 1,214 patients adult Tetralogy of Fallot patients being treated with late PVR versus those who had no further intervention as well as meta-regression analysis to evaluate the effect of time to PVR on incidence of ventricular arrhythmias. Summary odds ratio (OR) and 95% confidence intervals (CI) were estimated using random-effects model. We also examined the QRS duration, pooled mortality rate, RV volumes, and ejection fractions following late PVR.
Results: In 1,214 patients with Tetralogy of Fallot, the incidence of ventricular arrhythmias was less than 50% in patients with late PVR versus patients who did not have late PVR (OR 0.471, 95% CI 0.324-0.686, p <0.0001). On meta-regression, when plotting log odds ratio of incidence of ventricular arrhythmias (y-axis) against time of PVR replacement from original tetralogy of fallot repair (x-axis), incidence decreased with age (coefficient = 0.566, p=0.0001). The pooled mean difference in the indexed RV end-diastolic and end-systolic volume was −55 ml/m2 (95% CI −50 to −68) and −30 ml/m2 (95% CI −25 to −35), RV ejection fraction increased approximately 20% (95% CI −15% to 22%)m and QRS duration decreased 40 ms (95% CI −35 to 50 ms).
Conclusion: For patients with Tetralogy of Fallot after repair, there was a markedly higher rate of ventricular arrhythmias in patients who never received PVR compared to patients who had late PVR. Meta-regression showed a trend towards decreased incidence of ventricular arrhythmias with late PVR and increased age.