Author + information
- Received October 25, 1982
- Revision received January 24, 1983
- Accepted January 25, 1983
- Published online June 1, 1983.
- Arthur Garson Jr, MD, FACC*,
- Co-Burn J. Porter, MD,
- Paul C. Gillette, MD, FACC and
- Dan G. McNamara, MD, FACC
- ↵*Address for reprints: Arthur Garson, Jr., MD, Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin, Houston, Texas 77030.
An association among premature ventricular complexes on routine electrocardiogram, elevated right ventricular systolic pressure and sudden death after repair of tetralogy of Fallot was previously reported. To examine this relation further, noninvasive, hemodynamic and in-vasive electrophysiologic data were studied in 27 patients who had undergone repair of tetralogy of Fallot 7 months to 21 years (mean 1.75 years) previously. Syncope, which had occurred in four patients, was not significantly related to ventricular arrhythmia on rest electrocardiogram, 24 hour electrocardiogram or treadmill test. AH four patients with syncope had either nonsustained (two patients) or sustained (two patients) ventricular tachycardia induced at electrophysiologic study. His bundle to ventricle conduction interval was prolonged in two patients and Q to right ventricular apex interval was prolonged in three of the four patients. AH four had abnormal anatomic or hemodynamic findings: two had a right ventricular systolic pressure of 70 mm Hg or more, one had right ventricular dysfunction with tricuspid insufficiency and one a septal aneurysm. The 9 patients with induced nonsustained or sustained ventricular tachycardia were then compared with the 15 patients without induced ventricular arrhythmias. Those with ventricular tachycardia had a greater prevalence of: more complex ventricular arrhythmia on 24 hour electrocardiogram (63 versus 0%, p < 0.001), long His bundle to ventricle interval (44 versus 0%, p < 0.001), right ventricular systolic pressure of 70 mm Hg or more (56 versus 0%, p < 0.01) and reduced right ventricular ejection fraction (33 versus 7%, p < 0.025).
It is concluded that: 1) induction of nonsustained or sustained ventricular tachycardia was associated with a history of syncope; 2) all patients at risk for syncope could not be identified by routine electrocardiogram 24 hour electrocardiogram or treadmill test; 3) hemodynamic alterations may interact with intraventricular conduction abnormalities and predispose to ventricular tachycardia.
This study was supported in part by Grant HLO7 190 from the National Institutes of Health, U.S. Public Health Service and U.S. Public Health Service Grant RR00188 from General Clinical Research Branch. National Institutes of Health, Bethesda. Maryland and by a grant from the J. S. Abercrombie Foundation, Houston. Texas. Dr. Garson is a recipient of the National Institutes of Health Young Investigator Research Award HL24916 and Dr. Gillette is recipient of Research Career Development Award HL0057 I from the National Institutes of Health
- Received October 25, 1982.
- Revision received January 24, 1983.
- Accepted January 25, 1983.
- American College of Cardiology Foundation