Autonomic profile and arrhythmic risk stratification after surgical repair of tetralogy of Fallot

Abstract

Background Severe ventricular arrhythmias represent one of the main causes of mortality after repair of tetralogy of Fallot. Their appearance is primarily caused by the large ventricular scar created by surgical intervention. However, the role of autonomic activity as a modulating factor should be considered. The aim of our study was to evaluate this activity in a low-risk group of patients operated on for TOF and its correlation with the occurrence of sustained ventricular tachycardia. Methods and results The study group included 38 patients with a mean age of 31 ± 10 years, selected out of 76 subjects operated on for total correction of tetralogy of Fallot. After a mean interval of 21.9 ± 6 years from surgical procedure, they underwent electrocardiography, echocardiography, and time domain heart rate variability (HRV) analysis obtained by 24-hour Holter monitoring. Thirty-five healthy subjects comprised the control group for HRV analysis. During a mean follow-up of 6.2 ± 3 years, 8 patients experienced episodes of sustained ventricular tachycardia. Among different HRV parameters, the standard deviation of all normal beat intervals showed a significant reduction in this group of patients (91.7 ± 19 versus 133.4 ± 46, P < .02). Echocardiographic examination demonstrated an increased left ventricular end diastolic volume (85.6 ± 55 versus 61.3 ± 13 mL/m 2, P < .05) and a reduced left ventricle ejection fraction (53.9 ± 9 versus 61.0 ± 6 %, P < .01) in arrhythmic patients. QRS duration was similar in patients with or without sustained ventricular tachycardia. Conclusions Patients after surgical correction of tetralogy of Fallot, considered to be at low risk, showed a significant incidence of severe ventricular arrhythmias. HRV analysis seems to be a useful method for identifying arrhythmic patients, and the standard deviation of all normal beat intervals appears to be the more helpful index.