Trastornos del ritmo y de la conducción en pacientes operados de corrección total de tetralogía de Fallot

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Abstract

La tetralogía de Fallot es la cardiopatía congénita cianógena más común en la infancia. La reparación quirúrgica correctiva se ha utilizado por más de 40 años con excelentes resultados. Sin embargo, se ha reportado que las arritmias ventriculares malignas y la muerte súbita son las causas más frecuentes de mortalidad tardía después de la cirugía. Se ha utilizado el estudio electrofisiológico en pacientes seleccionados, pero su valor predictivo positivo aún es limitado a un pequeño grupo de pacientes. Los métodos exitosos de prevención de las arritmias ventriculares (la ablación y el desfibrilador ventricular implantable) en pacientes con alto riesgo han sido de mucha utilidad en estos enfermos.

Translated abstract

Tetralogy of Fallot is the most common cyanotic heart disease. Corrective intracardiac repair has been performed for > 40 years with excellent results. Nevertheless ventricular arrhythmias have consistently been reported, and sudden cardiac death is the most common cause of mortality late after repair. Programmed ventricular stimulation has been used in selected patients at many centers; however, attempts to clarify its predictive value have been limited by small patient number and relatively low event rates. The emergence of successful methods for both the prevention of arrhythmias, (including electrophysiological ablation and implantable defibrillators), has meant the identification of those at risk of even greater importance.

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Ventricular arrhythmias in postoperative tetralogy of Fallot.

Marco Bink, Ian M. Dick, S Beder … (1990)

Ventricular arrhythmias in patients after total surgical repair of tetralogy of Fallot have been associated with late sudden death. In this large multicenter retrospective study of 359 patients with postoperative tetralogy of Fallot, spontaneous ventricular premature complexes (VPCs) on 24-hour ambulatory electrocardiographic monitoring and laboratory-induced ventricular tachycardia (VT) by electrophysiologic stimulation were analyzed. The mean age at surgical repair was 5 years and the mean follow-up duration after repair was 7 years. Spontaneous VPCs on ambulatory monitoring were found in 48% and induced VT on electrophysiologic stimulation was found in 17% of patients. Both spontaneous VPCs and induced VT were significantly related to delayed age at repair, longer follow-up interval, symptoms of syncope or presyncope and right ventricular systolic hypertension (greater than 60 mm Hg) (p less than 0.05), but not to right ventricular diastolic pressure greater than 8 mm Hg. The VPCs on ambulatory monitoring were more complex with increasing age at repair and follow-up duration. Induction of VT on electrophysiologic stimulation correlated with spontaneous VPCs including VT on 24-hour ambulatory electrocardiographic monitoring. The electrophysiologic stimulation protocol varied and the induction of VT increased with a more aggressive stimulation protocol. While induced sustained monomorphic VT was related to all forms of spontaneous VPCs, induced nonsustained polymorphic VT was related to more complex forms of VPCs on ambulatory monitoring. VT was not induced in asymptomatic patients who had normal 24-hour ambulatory electrocardiographic monitoring and normal right ventricular systolic pressure. (ABSTRACT TRUNCATED AT 250 WORDS)