TY - JOUR
T1 - Preventing Arrhythmic Death in Patients With Tetralogy of Fallot
T2 - JACC Review Topic of the Week
AU - Cohen, Mitchell I.
AU - Khairy, Paul
AU - Zeppenfeld, Katja
AU - Van Hare, George F.
AU - Lakkireddy, Dhanunjaya R.
AU - Triedman, John K.
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/2/16
Y1 - 2021/2/16
N2 - Patients with tetralogy of Fallot are at risk for ventricular arrhythmias and sudden cardiac death. These abnormalities are associated with pulmonary regurgitation, right ventricular enlargement, and a substrate of discrete, slowly-conducting isthmuses. Although these arrhythmic events are rare, their prediction is challenging. This review will address contemporary risk assessment and prevention strategies. Numerous variables have been proposed to predict who would benefit from an implantable cardioverter-defibrillator. Current risk stratification models combine independently associated factors into risk scores. Cardiac magnetic resonance imaging, QRS fragmentation assessment, and electrophysiology testing in selected patients may refine some of these models. Interaction between right and left ventricular function is emerging as a critical factor in our understanding of disease progression and risk assessment. Multicenter studies evaluating risk factors and risk mitigating strategies such as pulmonary valve replacement, ablative strategies, and use of implantable cardiac-defibrillators are needed moving forward.
AB - Patients with tetralogy of Fallot are at risk for ventricular arrhythmias and sudden cardiac death. These abnormalities are associated with pulmonary regurgitation, right ventricular enlargement, and a substrate of discrete, slowly-conducting isthmuses. Although these arrhythmic events are rare, their prediction is challenging. This review will address contemporary risk assessment and prevention strategies. Numerous variables have been proposed to predict who would benefit from an implantable cardioverter-defibrillator. Current risk stratification models combine independently associated factors into risk scores. Cardiac magnetic resonance imaging, QRS fragmentation assessment, and electrophysiology testing in selected patients may refine some of these models. Interaction between right and left ventricular function is emerging as a critical factor in our understanding of disease progression and risk assessment. Multicenter studies evaluating risk factors and risk mitigating strategies such as pulmonary valve replacement, ablative strategies, and use of implantable cardiac-defibrillators are needed moving forward.
KW - arrhythmias
KW - implantable cardioverter-defibrillator
KW - sudden cardiac death
KW - tetralogy of Fallot
UR - http://www.scopus.com/inward/record.url?scp=85100057368&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2020.12.021
DO - 10.1016/j.jacc.2020.12.021
M3 - Review article
C2 - 33573746
AN - SCOPUS:85100057368
SN - 0735-1097
VL - 77
SP - 761
EP - 771
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -