Association Between Slowly Conducting Anatomical Isthmuses and Ventricular Tachycardia Inducibility in Tetralogy of Fallot

Waldmann, V; Moore, JP; Bessière, F; Babouri, N; Cohen, MI; O'Leary, ET; Patel, NS; Nazer, B; Tan, W; Fish, FA; Dalal, A; Mariucci, E; Tan, RB; Lloyd, MS; McLeod, CJ; Anderson, CC; Kanter, RJ; Johnson, BV; Wang, B; Chang, PM; Khairy, P

doi:10.1016/j.jacep.2025.08.008

Association Between Slowly Conducting Anatomical Isthmuses and Ventricular Tachycardia Inducibility in Tetralogy of Fallot

JACC Clin ElectrophysiolPublished 17 Sep 2025multicenter international cohort with retrospective (2017-2021) and prospective (commencing 2021) components

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Authors' conclusion

SCAI is highly prevalent in patients with TOF and is associated with inducible SMVT. However, the proportion of SCAI in noninducible patients is substantial, and some inducible patients have no SCAI. These findings suggest that SCAI alone is insufficient for arrhythmia management decisions, highlighting the need for an integrative approach combining electrophysiological study with other clinical parameters.

Study context

Population: Patients with tetralogy of Fallot (TOF) referred for electrophysiological study before transcatheter pulmonary valve replacementmean age 39.5 ± 14.2 years, 57.4% male
Participants: 162 patients

Exposure: The association between SCAI and sustained monomorphic ventricular tachycardia (SMVT) inducibility
Inducible SMVTn = 42
Outcome: SMVT induced

Main finding

As reported in the abstract

SMVT induced

42 (25.9%) patients

Observational data: associations, not effects.

Further findings

Prevalence of SCAI · higher in patients with inducible SMVT

P < 0.001

Inducible SMVT78.6%

Noninducible31.1%

SCAI independently associated with SMVT

	← Lower odds ←→ Higher odds →	OR (95% CI)
SCAIIndependent association	0.050.21520	6.4 (2.6–18.2)
	0.050.21520Odds ratio (log scale)

≥1 SCAI present

≥1 SCAI present: 76 (46.9%) patients

Substrate among patients with inducible SMVT without SCAI

Of patients with inducible SMVT, normally conducting anatomical isthmus or non-anatomical isthmus substrate: 21.4%
Of patients with inducible SMVT, normally conducting anatomical isthmus: 14.3%
Of patients with inducible SMVT, non-anatomical isthmus substrate: 7.1%

SCAI independently associated with SMVT

Association with other clinical parameters improved prediction of SMVT inducibility

SCAI in predicting SMVT inducibility

Area under the curve: 0.71
Sensitivity: 78.6%
Specificity: 64.2%

Original publication

Association Between Slowly Conducting Anatomical Isthmuses and Ventricular Tachycardia Inducibility in Tetralogy of Fallot. JACC Clin Electrophysiol. Published 17 September 2025. doi:10.1016/j.jacep.2025.08.008

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