Impact of Pulmonary Valve Replacement on Ventricular Arrhythmias in Patients With Tetralogy of Fallot and Implantable Cardioverter-Defibrillator - Université de Lorraine Access content directly
Journal Articles JACC: Clinical Electrophysiology Year : 2021

Impact of Pulmonary Valve Replacement on Ventricular Arrhythmias in Patients With Tetralogy of Fallot and Implantable Cardioverter-Defibrillator

1 Hôpital Louis Pradel [CHU - HCL]
2 CHU Pitié-Salpêtrière [AP-HP]
3 TIMONE - Hôpital de la Timone [CHU - APHM]
4 CHU Caen
5 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
6 CHU Nantes - Centre hospitalier universitaire de Nantes
7 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
8 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
9 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
10 CHU Bordeaux
11 CHU Amiens-Picardie
12 CHU Rouen
13 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
14 GHBS - Groupe Hospitalier Bretagne Sud
15 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
16 Clinique Pasteur [Toulouse]
17 CHU Sud Saint Pierre [Ile de la Réunion]
18 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
19 Centre hospitalier de Pau
20 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
21 CHU Clermont-Ferrand
22 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
23 CHU Dijon
24 CHU Limoges
25 HEGP - Hôpital Européen Georges Pompidou [APHP]
26 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
27 Centre Hospitalier Chalon-sur-Saône William Morey
28 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
29 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
30 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
31 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
Abdeslam Bouzeman
  • Function : Author
Fabien Labombarda
  • Function : Author
Pierre Bordachar
  • Function : Author
Alexis Hermida
Frédéric Anselme
Serge Boveda
Romain Eschalier
Charles Guenancia
Benoit Guy-Moyat
  • Function : Author
Roland Henaine
Didier Irles
François Jourda
  • Function : Author
Philippe Lagrange
  • Function : Author
  • PersonId : 774128
  • IdRef : 191064688
Mikael Laredo
Frédéric Sacher
  • Function : Author
Raphaël Martins
  • Function : Author
Jean Benoit Thambo
  • Function : Author
Eloi Marijon

Abstract

Objectives: This study aimed to assess the impact of pulmonary valve replacement (PVR) on ventricular arrhythmias burden in a population of tetralogy of Fallot (TOF) patients with continuous cardiac monitoring by implantable cardioverter-defibrillators (ICDs). Background: Sudden cardiac death is a major cause of death in TOF, and right ventricular overload is commonly considered to be a potential trigger for ventricular arrhythmias. Methods: Data were analyzed from a nationwide French ongoing study (DAI-T4F) including all TOF patients with an ICD since 2000. Survival data with recurrent events were used to compare the burden of appropriate ICD therapies before and after PVR in patients who underwent PVR over the study period. Results: A total of 165 patients (mean age 42.2 ± 13.3 years, 70.1% male) were included from 40 centers. Over a median follow-up period of 6.8 (interquartile range: 2.5 to 11.4) years, 26 patients (15.8%) underwent PVR. Among those patients, 18 (69.2%) experienced at least 1 appropriate ICD therapy. When considering all ICD therapies delivered before (n = 62) and after (n = 16) PVR, the burden of appropriate ICD therapies was significantly lower after PVR (HR: 0.21; 95% confidence interval [CI]: 0.08 to 0.56; p = 0.002). Respective appropriate ICD therapies rates per 100 person-years were 44.0 (95% CI: 35.7 to 52.5) before and 13.2 (95% CI: 7.7 to 20.5) after PVR (p < 0.001). In the overall cohort, PVR before ICD implantation was also independently associated with a lower risk of appropriate ICD therapy in primary prevention patients (HR: 0.29 [95% CI: 0.10 to 0.89]; p = 0.031). Conclusions: In this cohort of high-risk TOF patients implanted with an ICD, the burden of appropriate ICD therapies was significantly reduced after PVR. While optimal indications and timing for PVR are debated, these findings suggest the importance of considering ventricular arrhythmias in the overall decision-making process. (French National Registry of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator [DAI-T4F]; NCT03837574).
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Dates and versions

hal-03233026 , version 1 (01-11-2022)

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Francis Bessière, Kévin Gardey, Abdeslam Bouzeman, Guillaume Duthoit, Linda Koutbi, et al.. Impact of Pulmonary Valve Replacement on Ventricular Arrhythmias in Patients With Tetralogy of Fallot and Implantable Cardioverter-Defibrillator. JACC: Clinical Electrophysiology, 2021, 7 (10), pp.1285-1293. ⟨10.1016/j.jacep.2021.02.022⟩. ⟨hal-03233026⟩
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