Hostname: page-component-cd4964975-g4d8c Total loading time: 0 Render date: 2023-03-27T18:31:16.494Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Ventricular arrhythmias after repair of congenital heart disease: Who needs treatment?

Published online by Cambridge University Press:  19 August 2008

Arthur Garson Jr*
Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston
Dr. Arthur Garson, Jr., Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin, Houston, Texas 77030USA


Sudden death occurs in patients after repair of congenital heart disease. In those with tetralogy of Fallot, or a similar lesion, ventricular tachycardia has been hypothesized as the major arrhythmic mechanism for sudden death. It would be desirable to identify individuals at risk for sudden death, to determine which arrhythmia would be likely to cause sudden death, and to treat those individuals with an appropriate antiarrhythmic to prevent sudden death. For the last 10 years, physicians have been treating patients with antiarrhythmic drugs, based on a number of criteria, the most common of which is the presence of premature ventricular contractions.1,2 The practice has recently been called into question by the CAST trial. It is the purpose of this paper to review the evidence that repair causes ventricular arrhythmias, that ventricular arrhythmias cause sudden death, and that ventricular arrhythmias should be treated prophylactically.

Special Articles
Copyright © Cambridge University Press 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1.Garson, A, Randall, DG, McVey, P, Smith, RT, Moak, JP, Gillette, PC, McNamara, DG. Prevention ofsudden death after repair of tetralogy of Fallot: treatment of ventricular arrhyth miss. J Am Coil Cardiol 1985; 6: 221227.CrossRefGoogle Scholar
2.Fish, FA, Gillette, PC, Benson, DW. Incidence ofdeath, cardiac arrest and proarrhythmia in young patients receiving flecainide or encainide. Circulation 1989; 80(Suppl II): 11387.Google Scholar
3.Wolff, GS, Rowland, TW, Ellison, RC. Surgically induced right bundle branch block with left anterior hemiblock: an ominous sign in postoperative tetralogy of Fallot. Circulation 1972; 46: 587594.CrossRefGoogle ScholarPubMed
4.James, FW, Kaplan, S, Chou, T. Unexpected cardiac arrest in patients after surgical correction of tetralogy of Fallot. Circulation 1975; 52: 691695.CrossRefGoogle ScholarPubMed
5.Garson, A, Nihili, MR, McNamara, DG, Cooley, DA. Status of the adult and adolescent following repair of tetralogy of Fallot. Circulation 1979; 59: 12321240.CrossRefGoogle Scholar
6.Fuster, V, McGoon, DC, Kirklin, JW. Long-term evaluation (12–22 years) of open heart surgery for tetralogy of Faliot. Am J Cardiol 1980; 46: 635642.CrossRefGoogle Scholar
7.Deanfield, JE, McKenna, WJ, Hallidie-Smith, KA. Detection of late arrhythmia and conduction disturbance after correction of tetralogy of Faliot. Br Heart J 1980; 44: 248253.CrossRefGoogle Scholar
8.Katz, NM, Blackstone, EH, Kirklin, JW. Late survival and symptoms after repair of tetralogy ofFallot. Circulation 1982; 65: 403410.CrossRefGoogle Scholar
9.Miyamura, H, Kanazawa, H, Matsukawa, T. Long-term post operative status of tetralogy of Fallot. Jpn Circ J 1986; 50: 855858.CrossRefGoogle Scholar
10.Vaksmann, G, Fournier, A, Davignon, A. Incidence and prog nosis ofarrhythmias in postoperative tetralogy of Fallot: long-term follow-up study. Circulation 1988; 80(SupplII): 11597.Google Scholar
11.Sullivan, ID, Presbitero, P, Deanfleld, JE. Is ventricular arrhythmia in repaired retralogy of Fallot an efFect ofoperation or a consequence of the course of the disease? Bri Heart J 1987; 58: 4044.CrossRefGoogle ScholarPubMed
12.Tamer, D, Wolff, GS, Geiband, H. Hemodynamics and intracardiac conduction after operative repair of tetralogy of Fallot. Am J Cardiol 1983; 51: 552556.CrossRefGoogle ScholarPubMed
13.Zimmermann, M, Friedli, B, Oberhansli, I. Frequency of ventricular late potentials and factioned right ventricular electrograms after operative repair of tetralogy of Fallot. Am J Cardiol 1987; 59: 448453.CrossRefGoogle ScholarPubMed
14.Horowitz, LN, Vetter, VL, Harken, AH, Josephson, ME. Eiectrophysiologic characteristics of sustained ventriculartachycardia occurring after repair of tetralogy of Failot. Am J Cardiol 1980; 46: 446452.CrossRefGoogle Scholar
15.Kugler, JD, Pinsky, WW, Fleming, WH. Sustained ventriculartachycardia after repair of tetralogy of Failot: newelectrophysiologic findings. Am J Cardiol 1983; 51: 11371143.CrossRefGoogle Scholar
16.Dunnigan, A, Benditt, DL, Benson, DW. Life threatening ventricular tachycardias in late survivors ofsurgically corrected tetralogy of Fallot. Br Heart J 1984; 52: 198206.CrossRefGoogle ScholarPubMed
17.Swerdlow, CD, Oyer, PE, Pitlick, PT. Septal origin ofsustained ventricular tachycardia in a patient with right ventricular outflow tract obstruction after correction of tetralogy of Faliot. PACE 1986; 9: 585588.CrossRefGoogle Scholar
18.Walsh, EP, Keane, JF, Hougen, TJ. Late results in patients with tetralogy of Fallot repaired during infancy. Circulation 1988; 77: 10621067.CrossRefGoogle ScholarPubMed
19.Chandar, JS, Wolff, GS, Garson, A, Bell, TJ, Beder, SD, Bink-Boelkens, M, Byrum, CJ, Campbell, RM, Deal, BJ, Dick, M II, Flinn, CJ, Gaum, WE, Gillette, PC, Hordof, AJ, Kugler, JD, Porta, CJ, Walsh, EP. Ventricular arrhythmias in postoperative tetralogy of Fallot. Am J Cardiol 1990; 65: 655661.CrossRefGoogle ScholarPubMed
20.DenfIeld, SW, Kearney, DL, Michael, L, Gittenberger-de, Groot A, Garson, A. Growth in cardiac surgical scars with age: a canine model. J Am Coil Cardiol 1990; 15: 176A.CrossRefGoogle Scholar
21.Ewing, L, Gillette, PC. Only 8% of postoperative tetralogy patients have inducible dysrhythmias. J Am Coil Cardiol 1987; 9: 36A.Google Scholar
22.Deanfleld, JE, Anderson, RH, Hallidie-Smith, KA. Late sudden death after repair of tetralogy of Faliot: a clinicopathologic study. Circulation 1983; 67: 626631.CrossRefGoogle Scholar
23.Garson, A, Bink-Boelkens, M, Hesslein, PS, Hordoff, AJ, Keane, JF, Neches, WH, Porter, CJ. Atrial flutter in the young: a col laborative study of 380 cases. J Am Coil Cardiol 1985; 6: 871878.CrossRefGoogle Scholar
24.Dreyer, WJ, Paridon, SM, Varughese, A, Fisher, DJ, Garson, A. Serum norepinephrine elevation in dogs with high right ventricular pressure during simulated ventricular tachycardia. Am J Cardiol 1987; 60(SupplI): 1639.Google Scholar
25.Garson, A, Gillette, PC. Treatment of chronic ventricular dysrhythmias in the young. PACE 1981; 4: 658669.CrossRefGoogle Scholar
26.Morganroth, J, Michelson, EL, Horowitz, LN. Limitations of routine long-term electrocardiographic monitoring to assess ventricular ectopic frequency. Circulation 1978; 58: 408413.CrossRefGoogle ScholarPubMed