Arrhythmias & electrophysiology
Age-Related Ventricular Tachycardia Substrate Characteristics for Repaired Tetralogy of Fallot Before Transcatheter Pulmonary Valve Placement
Authors' conclusion
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.
Study context
- Population
- Repaired tetralogy of Fallot (rTOF) patients with native right ventricular outflow tract referred for electrophysiology study (EPS) before transcatheter pulmonary valve replacement (TPVR)mean age 39 ± 14 years, 54% male · retrospective 71 · prospective 109
- Participants
- 180 patients
- Outcome
- Monomorphic VT induced at EPS
Methodological detailscommencing 2021
- Commencing 2021
Main finding
As reported in the abstract
Monomorphic ventricular tachycardia (VT) induced
45
25%
Slowly conducting anatomic isthmus alone
40
22%
Observational data: associations, not effects.
Further findings
Age-related VT substrate changes
- VT isthmus conduction velocity decreased
- −0.08 m/s per decade; P = 0.008
- VT inducibility increased with age
- P < 0.001 for trend
- Cycle length (CL) increased with age
- +15 ms per decade, P = 0.005
Multivariable factors associated with shorter VT CL
- Preserved isthmus conduction velocity
- −50 ms per m/s; P = 0.02
- Absence of atrial flutter
- −18 ms; P = 0.007
- Improved RV ejection fraction
- −16 ms per 10% increase; P = 0.007
Acute success of catheter ablation
- Catheter ablation acutely successful
- 80/83 (96%)
Repeated EPS findings · median of 5 months
- Previously ablated substrates evident
- 3/24 (13%)
- New VT substrates
- 3/33 (9%)
Original publication
Age-Related Ventricular Tachycardia Substrate Characteristics for Repaired Tetralogy of Fallot Before Transcatheter Pulmonary Valve Placement. JACC Clin Electrophysiol. Published 15 January 2025. doi:10.
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