Low Incidence of Arrhythmias in the Right Ventricular Infundibulum Sparing Approach to Tetralogy of Fallot Repair

Abstract

To improve outcomes, including arrhythmia incidence, for patients with tetralogy of Fallot (TOF), the authors' institution adopted an approach that minimizes or avoids transmural incision of the right ventricular outflow tract. When pulmonary blood flow is insufficient during the neonatal period, placement of an aortopulmonary artery shunt is preferred, followed by complete repair later in infancy. This study reviewed the perioperative and mid-term arrhythmia outcomes at the authors' institution using this approach. Patients who underwent TOF repair from 1995 to 2008 were included in the study. Patient demographics and surgical history were collected. The primary end points of the study included documented perioperative arrhythmias and arrhythmias at the 10-year follow-up assessment. Of the 298 patients who underwent TOF repair, 50 (17%) had undergone prior placement of a systemic-to-pulmonary artery shunt. The median age at repair was 9.7months (interquartile range, 6.3-16.2months). Clinically significant perioperative arrhythmias were found in 12 patients (4%) including 6 junctional tachycardias, 4 atrial tachycardias, and 1 temporary complete heart block. No patients were receiving antiarrhythmic medications more than 24months after surgery. Of the 298 patients, 86 (29%) had a follow-up period of 10years or longer (median, 12.2years). No patients experienced new arrhythmias, received antiarrhythmic therapy, experienced post-discharge ventricular tachycardia, had atrioventricular block, or required a pacemaker or defibrillator. The right ventricular infundibulum sparing approach is associated with an extremely low incidence of perioperative and midterm arrhythmias. The perioperative and mid-term outcomes compare favorably with existing data from programs favoring neonatal repair. Long-term follow-up evaluation is essential to determine whether this strategy can effectively alter late pathophysiology and minimize late-term arrhythmias and associated mortality.