Ventricular arrhythmias following percutaneous pulmonary valve implantation in the pediatric population: An observational single center study

Abstract

We sought to evaluate the incidence of severe ventricular arrhythmias (VAs) following percutaneous pulmonary valve implantation (PPVI) on an entirely pediatric population and to investigate for possible predictive factors. Reports including patients of various ages have shown a significant increase in the incidence of transient mild VAs early after PPVI. A retrospective chart review of all pediatric patients (age at PPVI <20 years) who underwent PPVI in our institution from January 2007 to December 2019 was performed. Severe VAs (sustained and/or hemodynamically unstable ventricular tachycardia, inducible arrhythmia during an electrophysiologic study [EPS], presumed sudden arrhythmic death) were recorded. A total of 21 patients (mean age 16.2 years [12.2–19.3]; 66.7% male) underwent PPVI. Tetralogy of Fallot (TOF) was the most common congenital heart disease diagnosis (n = 11/21, 52.4%) and pulmonary insufficiency ( n = 10, 47.6%) the main indication. Mean follow-up was 1.44-year (0.05–4.30 years). Severe VAs occurred in 3/21 (14.3%) patients aged 15.5 (14.7–16.1 years) at a median time of 12 months (10–32 months) after PPVI. All events occurred in patients with TOF-like physiology following Melody valve implant. None of the established non-invasive risk factors could predict the occurrence of these events. Severe VAs can occur in pediatric patients long after the PPVI, even in the absence of any established non-invasive arrhythmic risk factors. An invasive EPS may be a useful additional tool to risk-stratify patients and should be part of systematic pulmonary pre-valvulation evaluation.