Pediatric/Adult Congenital Heart Disease -> Adult Congenital Heart Disease D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-122 - The Role Of Intervention In The Management Of Ventricular Arrhythmia In Tetralogy Of Fallot With Secondary Prevention Implantable Cardioverter Defibrillator Therapy (ID 910)

Abstract

Background: The implantable cardioverter defibrillator (ICD) has proven to prevent sudden cardiac death (SCD) in Tetralogy of Fallot (TOF). Although ICD therapies for recurrent arrhythmias can be lifesaving, the shocks can have deleterious consequences. Invasive therapy such as catheter ablation (RFCA) and surgical ablation (SA) has become a standard of care to prevent ICD shocks in general population. However, little is known about the efficacy and safety of invasive therapy in the management of recurrent ventricular arrhythmia (VA) in patients with TOF.
Objective: The purpose of this study was to examine the efficacy and safety of RFCA and SA for VA in patients with TOF.
Methods: A total of 46 TOF patients who underwent secondary ICD implantation between 1999 and 2019 were included in this study.
Results: At implantation, mean age was 42.3±14.0 years and 68.8% (n=33) was male. CRTD were implanted in 5 (10.4%) patients. Of all patients, 20 (43.4%) underwent invasive therapy (RFCA: n=9, SA: n=11) before ICD implantation. During mean follow up periods of 92.5±69.5 months, 2 (10.0%, 1.9%/year) patients and 9 (34.6%, 5.2%/year) patients developed appropriate ICD shock in invasive and non-invasive therapy, respectively (P=0.044) (Figure). Moreover, invasive therapy significantly decreased the risk of composite outcomes of death, cardiac transplantation and hospital admission (P=0.032) compared to non-invasive group.
Conclusion: Preventing recurrent VA is still challenging in TOF patients with secondary prevention. However, invasive therapy before device implantation can aid in prevention of lethal events in the future.
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