Age-Related Ventricular Tachycardia Substrate Characteristics for Repaired Tetralogy of Fallot Before Transcatheter Pulmonary Valve Placement

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Clinical electrophysiology Pub Date : 2025-03-01 DOI:10.1016/j.jacep.2024.11.005

Jeremy P. Moore MD, MS , Victor Waldmann MD, PhD , Francis Bessière MD, PhD , Nawel Babouri MS , Mitchell I. Cohen MD , Edward T. O’Leary MD , Nimesh S. Patel MD , Babak Nazer MD , Weiyi Tan MD , Frank A. Fish MD , Aarti S. Dalal DO , Elisabetta Mariucci MD, PhD , Reina B. Tan MD , Michael S. Lloyd MD , Christopher J. McLeod MBChB, PhD , Charles C. Anderson MD , Ronald J. Kanter MD , Bryce V. Johnson MD , Bo Wang MD , Philip M. Chang MD , Paul Khairy MD, PhD

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Abstract

Background

Ventricular tachycardia (VT) substrate characteristics before transcatheter pulmonary valve replacement (TPVR) in repaired tetralogy of Fallot (rTOF) are unknown.

Objectives

In this study, the authors sought to evaluate substrates for sustained monomorphic VT before TPVR in rTOF.

Methods

Retrospective (2017 to 2021) and prospective (commencing 2021) rTOF patients with native right ventricular outflow tract referred for electrophysiology study (EPS) before TPVR were included. Electrophysiologic findings and outcomes of VT ablation were determined.

Results

A total of 180 patients (mean age 39 ± 14 years, 54% male, 71 retrospective, 109 prospective) were identified. At EPS, monomorphic VT was induced in 45 (25%), and a slowly conducting anatomic isthmus alone was observed in 40 (22%). VT isthmus conduction velocity decreased (−0.08 m/s per decade; P = 0.008) and VT inducibility (P < 0.001 for trend) and cycle length (CL) (+15 ms per decade, P = 0.005) increased with age. Multivariable factors associated with shorter VT CL included preserved isthmus conduction velocity (−50 ms per m/s; P = 0.02), absence of atrial flutter (−18 ms; P = 0.007), and improved RV ejection fraction (−16 ms per 10% increase; P = 0.007). Catheter ablation was acutely successful in 80/83 (96%). At repeated EPS after a median of 5 months, previously ablated substrates were evident in 3/24 (13%) and new VT substrates in 3/33 (9%).

Conclusions

Pre-TPVR VT substrates in rTOF demonstrate age-related degeneration that was associated with VT inducibility and VT CL. Both recovery of VT isthmus conduction and new VT substrates were observed after TPVR despite successful catheter ablation.

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经导管置放肺动脉瓣前修复法洛四联症的年龄相关性室性心动过速底物特征。

背景：经导管肺动脉瓣置换术（TPVR）修复法洛四联症（rTOF）患者室性心动过速（VT）底物特征尚不清楚。目的：在这项研究中，作者试图评估rTOF患者在TPVR之前持续单形态VT的底物。方法：回顾性（2017年至2021年）和前瞻性（从2021年开始）纳入在TPVR前进行电生理研究（EPS）的先天性右心室流出道rTOF患者。测定电生理结果和室速消融结果。结果：180例患者（平均年龄39±14岁，男性54%，71例为回顾性，109例为前瞻性）。在EPS处，45例（25%）出现单形态性室速，40例（22%）出现解剖性峡部缓慢传导。VT峡部传导速度下降（-0.08 m/s / 10年）；P = 0.008)， VT诱导率（趋势P < 0.001）和周期长度（CL）（+15 ms / 10年，P = 0.005）随年龄增加而增加。与较短VT CL相关的多变量因素包括保留的峡部传导速度(-50 ms / m/s；P = 0.02)，无心房扑动(-18 ms；P = 0.007)，右心室射血分数提高(每增加10% -16 ms；p = 0.007)。83例患者中有80例（96%）急性消融成功。在中位5个月后重复EPS时，3/24（13%）有先前消融的底物，3/33（9%）有新的VT底物。结论：tpvr前rTOF的VT底物表现出与VT诱导性和VT CL相关的年龄相关性变性。在导管消融成功的情况下，TPVR术后观察到室速峡部传导恢复和新的室速基底。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.