Ventricular tachycardia after repair of congenital heart disease

Abstract

This study examined patients with known ventricular tachycardia after repair of congenital heart disease to determine prognosis and identify possible risk factors for sudden death. The charts of 76 patients seen at Texas Children's Hospital between 1984 and 1989 with ventricular tachycardia after repair of congenital heart disease were reviewed. Clinical and hemodynamic status were assessed. Mean age of primary repair was 7.7 years (0.3–29.3) and average follow-up was 11.3 years (0.3–33.8). Of the ten patients who died, four died suddenly. Ten patients (13%) experienced cardiac arrest, which occurred in 36% of patients with ‘poor’, 17% with ‘fair’, and 3% with ‘good’ clinical status. All seven evaluated cardiac arrest patients had ‘poor’ hemodynamics, compared to 62% ( 28 45 ) of others. Although syncope was a common event ( 14 76 ), no patient who arrested had prior syncope. Of the 20 patients who underwent surgical revision, ventricular tachycardia persisted in 17. Conclusions: (1) 13% of patients with ventricular tachycardia after the repair of congenital heart disease experienced cardiac arrest. (2) No cardiac arrest patient in this series had prior syncope, making this a non-specific symptom. (3) Patients with clinical and catheterization findings suggestive of the worst hemodynamics were most likely to have cardiac arrest. (4) Surgical intervention did not prove successful in eliminating ventricular tachycardia or preventing cardiac arrest.