The following is a summary of “THE IMPACT OF LATE PULMONIC VALVE REPLACEMENT ON VENTRICULAR ARRHYTHMIAS ASSOCIATED WITH TETRALOGY OF FALLOT (TOF) IN ADULTS,” published in the March 2023 issue of Cardiology by Khalid, et al.

Survivors of Tetralogy of Fallot (TOF) repair may develop arrhythmias, but the optimal timing for pulmonary valve replacement (PVR) and its impact on subsequent ventricular tachycardias remains uncertain.

A meta-analysis of 12 studies was conducted to identify 1,740 patients with TOF and ventricular arrhythmias after initial repair to compare patients with late PVR and those without further intervention. Additionally, a meta-regression analysis was performed to evaluate the effect of age and time on PVR on ventricular arrhythmia incidence. Summary odds ratios (OR) and 95% CI were estimated using a random-effects model.

Patients with late PVR had almost 60% lower cumulative incidence of ventricular arrhythmias than those without PVR (OR 0.40, 95% CI 0.22-0.73, P<0.003). A significant reduction in right ventricular end-diastolic volume (RV-EDV) was observed after PVR (random-effects model: -1.44, SE = 0.188, P<0.0001). Reduction in RV-EDV following late PVR was associated with a significant reduction in ventricular arrhythmias. 

Meta-regression analysis showed a trend towards a decreased incidence of ventricular arrhythmias in patients with late PVR and increased incidence with increasing age. Statistically significant coefficients were observed for changes in post-operative RV ejection fraction (EF) and RV-EDV but not for ventricular tachycardia (VT) incidence, regarding pre-operative RV-EDV. Significant coefficients were observed for changes in post-operative RV EF and post-operative RV-EDV but not for VT incidence regarding pre-operative QRS.

Patients with TOF who underwent late PVR had a substantially lower incidence of ventricular arrhythmias than those without PVR. Late PVR was associated with lower mortality rates. The meta-regression analysis suggested a trend toward reduced incidence of ventricular arrhythmias in patients with late PVR and increased incidence with increasing age.

Source: jacc.org/doi/10.1016/S0735-1097%2823%2900477-1