Role of right ventricular three-dimensional electroanatomic voltage mapping for arrhythmic risk stratification of patients with corrected tetralogy of Fallot or other congenital heart disease involving the right ventricular outflow tract

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Abstract

Background The post-surgical history of repaired congenital heart disease (rCHD), in particular tetralogy of Fallot (TOF), is often complicated by sudden death. Electrical myocardial abnormalities could be a substrate for malignant ventricular arrhythmias. Methods and results 146 patients with TOF or other rCHD involving a subpulmonary right ventricle, considered to be at high arrhythmic risk, underwent right ventricular (RV) electroanatomic voltage mapping (EVM). Maps showed endocardial scars (<0.5 mV) in all cases, mainly involving the RV outflow tract (n = 141, 96.6%). In 28 cases (19.2%), other areas were involved. Total scar extension, expressed as % of total endocardial area, was significantly higher in patients with QRS ≥ 180 ms [4.5% (± 2.5) vs 2.8% (± 2.4), p = 0.014], left and right ventricular systolic dysfunction [4.5% (± 3.2) vs 2.8% (± 2.3), p = 0.016 and 3.5% (± 3.0) vs 2.6% (± 1.9), p = 0.03, respectively], premature ventricular contractions (PVCs) [3.2% (± 2.6) vs 2.2% (± 1.8), p <0.05], exercise-induced PVCs [3.8% (± 2.4) vs 2.6% (± 2.2), p = 0.01], previous shunt [4.0% (± 2.7) vs 2.6% (± 2.2), p = 0.01] and reintervention [4.2% (± 3.2) vs 2.6% (± 2.0), p = 0.008]. Scar size also showed a positive correlation with duration of post-surgical follow-up (ρ = 0.01), age at correction (ρ = 0.01) and absolute QRS duration (ρ = 0.05). Conclusions Patients with rCHD involving the right ventricle show electrical scars with variable distribution, not necessarily matching with sites of surgical lesions. Scar extension correlates with some of the risk factors for life-threatening arrhythmias in CHD, such as prolonged QRS. Thus EVM could be considered an additional tool in the assessment of risk stratification in this particular population.

Original languageEnglish
Pages (from-to)422-429
Number of pages8
JournalInternational Journal of Cardiology
Volume222
DOIs
Publication statusPublished - Nov 1 2016

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Tetralogy of Fallot
Cicatrix
Heart Diseases
Ventricular Premature Complexes
Heart Ventricles
Cardiac Arrhythmias
Right Ventricular Dysfunction
Sudden Death
History
Exercise
Population

Keywords

  • Congenital heart disease
  • Electrophysiology mapping
  • Sudden cardiac death
  • Tetralogy of Fallot
  • Ventricular tachycardia arrhythmia

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

@article{224f33cd96c1418a9a9e3a7fefb3f7db,
title = "Role of right ventricular three-dimensional electroanatomic voltage mapping for arrhythmic risk stratification of patients with corrected tetralogy of Fallot or other congenital heart disease involving the right ventricular outflow tract",
abstract = "Background The post-surgical history of repaired congenital heart disease (rCHD), in particular tetralogy of Fallot (TOF), is often complicated by sudden death. Electrical myocardial abnormalities could be a substrate for malignant ventricular arrhythmias. Methods and results 146 patients with TOF or other rCHD involving a subpulmonary right ventricle, considered to be at high arrhythmic risk, underwent right ventricular (RV) electroanatomic voltage mapping (EVM). Maps showed endocardial scars (<0.5 mV) in all cases, mainly involving the RV outflow tract (n = 141, 96.6{\%}). In 28 cases (19.2{\%}), other areas were involved. Total scar extension, expressed as {\%} of total endocardial area, was significantly higher in patients with QRS ≥ 180 ms [4.5{\%} (± 2.5) vs 2.8{\%} (± 2.4), p = 0.014], left and right ventricular systolic dysfunction [4.5{\%} (± 3.2) vs 2.8{\%} (± 2.3), p = 0.016 and 3.5{\%} (± 3.0) vs 2.6{\%} (± 1.9), p = 0.03, respectively], premature ventricular contractions (PVCs) [3.2{\%} (± 2.6) vs 2.2{\%} (± 1.8), p <0.05], exercise-induced PVCs [3.8{\%} (± 2.4) vs 2.6{\%} (± 2.2), p = 0.01], previous shunt [4.0{\%} (± 2.7) vs 2.6{\%} (± 2.2), p = 0.01] and reintervention [4.2{\%} (± 3.2) vs 2.6{\%} (± 2.0), p = 0.008]. Scar size also showed a positive correlation with duration of post-surgical follow-up (ρ = 0.01), age at correction (ρ = 0.01) and absolute QRS duration (ρ = 0.05). Conclusions Patients with rCHD involving the right ventricle show electrical scars with variable distribution, not necessarily matching with sites of surgical lesions. Scar extension correlates with some of the risk factors for life-threatening arrhythmias in CHD, such as prolonged QRS. Thus EVM could be considered an additional tool in the assessment of risk stratification in this particular population.",
keywords = "Congenital heart disease, Electrophysiology mapping, Sudden cardiac death, Tetralogy of Fallot, Ventricular tachycardia arrhythmia",
author = "Fabrizio Drago and Vincenzo Pazzano and {Di Mambro}, Corrado and Russo, {Mario Salvatore} and Rosalinda Palmieri and Silvetti, {Massimo Stefano} and Salvatore Giannico and Benedetta Leonardi and Antonio Amodeo and {Di Ciommo}, {Vincenzo Maria}",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.ijcard.2016.07.231",
language = "English",
volume = "222",
pages = "422--429",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Role of right ventricular three-dimensional electroanatomic voltage mapping for arrhythmic risk stratification of patients with corrected tetralogy of Fallot or other congenital heart disease involving the right ventricular outflow tract

AU - Drago, Fabrizio

AU - Pazzano, Vincenzo

AU - Di Mambro, Corrado

AU - Russo, Mario Salvatore

AU - Palmieri, Rosalinda

AU - Silvetti, Massimo Stefano

AU - Giannico, Salvatore

AU - Leonardi, Benedetta

AU - Amodeo, Antonio

AU - Di Ciommo, Vincenzo Maria

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background The post-surgical history of repaired congenital heart disease (rCHD), in particular tetralogy of Fallot (TOF), is often complicated by sudden death. Electrical myocardial abnormalities could be a substrate for malignant ventricular arrhythmias. Methods and results 146 patients with TOF or other rCHD involving a subpulmonary right ventricle, considered to be at high arrhythmic risk, underwent right ventricular (RV) electroanatomic voltage mapping (EVM). Maps showed endocardial scars (<0.5 mV) in all cases, mainly involving the RV outflow tract (n = 141, 96.6%). In 28 cases (19.2%), other areas were involved. Total scar extension, expressed as % of total endocardial area, was significantly higher in patients with QRS ≥ 180 ms [4.5% (± 2.5) vs 2.8% (± 2.4), p = 0.014], left and right ventricular systolic dysfunction [4.5% (± 3.2) vs 2.8% (± 2.3), p = 0.016 and 3.5% (± 3.0) vs 2.6% (± 1.9), p = 0.03, respectively], premature ventricular contractions (PVCs) [3.2% (± 2.6) vs 2.2% (± 1.8), p <0.05], exercise-induced PVCs [3.8% (± 2.4) vs 2.6% (± 2.2), p = 0.01], previous shunt [4.0% (± 2.7) vs 2.6% (± 2.2), p = 0.01] and reintervention [4.2% (± 3.2) vs 2.6% (± 2.0), p = 0.008]. Scar size also showed a positive correlation with duration of post-surgical follow-up (ρ = 0.01), age at correction (ρ = 0.01) and absolute QRS duration (ρ = 0.05). Conclusions Patients with rCHD involving the right ventricle show electrical scars with variable distribution, not necessarily matching with sites of surgical lesions. Scar extension correlates with some of the risk factors for life-threatening arrhythmias in CHD, such as prolonged QRS. Thus EVM could be considered an additional tool in the assessment of risk stratification in this particular population.

AB - Background The post-surgical history of repaired congenital heart disease (rCHD), in particular tetralogy of Fallot (TOF), is often complicated by sudden death. Electrical myocardial abnormalities could be a substrate for malignant ventricular arrhythmias. Methods and results 146 patients with TOF or other rCHD involving a subpulmonary right ventricle, considered to be at high arrhythmic risk, underwent right ventricular (RV) electroanatomic voltage mapping (EVM). Maps showed endocardial scars (<0.5 mV) in all cases, mainly involving the RV outflow tract (n = 141, 96.6%). In 28 cases (19.2%), other areas were involved. Total scar extension, expressed as % of total endocardial area, was significantly higher in patients with QRS ≥ 180 ms [4.5% (± 2.5) vs 2.8% (± 2.4), p = 0.014], left and right ventricular systolic dysfunction [4.5% (± 3.2) vs 2.8% (± 2.3), p = 0.016 and 3.5% (± 3.0) vs 2.6% (± 1.9), p = 0.03, respectively], premature ventricular contractions (PVCs) [3.2% (± 2.6) vs 2.2% (± 1.8), p <0.05], exercise-induced PVCs [3.8% (± 2.4) vs 2.6% (± 2.2), p = 0.01], previous shunt [4.0% (± 2.7) vs 2.6% (± 2.2), p = 0.01] and reintervention [4.2% (± 3.2) vs 2.6% (± 2.0), p = 0.008]. Scar size also showed a positive correlation with duration of post-surgical follow-up (ρ = 0.01), age at correction (ρ = 0.01) and absolute QRS duration (ρ = 0.05). Conclusions Patients with rCHD involving the right ventricle show electrical scars with variable distribution, not necessarily matching with sites of surgical lesions. Scar extension correlates with some of the risk factors for life-threatening arrhythmias in CHD, such as prolonged QRS. Thus EVM could be considered an additional tool in the assessment of risk stratification in this particular population.

KW - Congenital heart disease

KW - Electrophysiology mapping

KW - Sudden cardiac death

KW - Tetralogy of Fallot

KW - Ventricular tachycardia arrhythmia

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U2 - 10.1016/j.ijcard.2016.07.231

DO - 10.1016/j.ijcard.2016.07.231

M3 - Article

AN - SCOPUS:84980430611

VL - 222

SP - 422

EP - 429

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -