Author + information
- Received November 13, 1984
- Revision received January 21, 1985
- Accepted February 21, 1985
- Published online July 1, 1985.
- Arthur Garson Jr., MD, FACCa,b,
- David C. Randall,
- Paul C. GilletteD,
- Richard T. Smith, MD,
- Jeffrey P. Moak, MD,
- Pat McVey, RN and
- Dan G. McNamara, MD, FACC
- ↵aAddress for reprints: Arthur Garson, Jr., MD, Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin, Houston, Texas 77030.
The majority of sudden deaths after repair of tetralogy of Fallot have been presumed to be due to ventricular arrhythmia; however, it remains to be demonstrated that antiarrhythmic medication reduces the incidence of sudden death. Since 1978, ventricular arrhythmias have been treated aggressively; these include any ventricular arrhythmia on routine electrocardiogram and more than 10 uniform premature ventricular complexes per hour on 24 hour electrocardiogram. A review was undertaken of 488 patients followed up for more than 1 month after repair of tetralogy of Fallot (mean follow-up time 6.1 gears); 13.5% had ventricular arrhythmia on routine electrocardiogram. Ventricular arrhythmia appeared from 2 months to 21 years postoperatively (mean 7.3 g ears). Ventricular arrhythmias were significantly (p < 0.01) related to: longer follow-up duration, older age at follow-up, older age at operation and higher postoperative right ventricular systolic and end-diastolic pressures. Ventricular arrhythmia on routine electrocardiogram occurred in 100% of those who later died suddenly compared with 12% of those who did not die (p < 0.01). Treatment for ventricular arrhythmia was given to 46 patients and considered “successful” if there were fewer than 10 uniform premature ventricular complexes per hour on 24 hour electrocardiogram. A successful drug was found in 44 of the 46: 30 of 34 given phenytoin, 6 of 9 given propranolol, 1 of 7 given quinidine, 1 of 2 given disopyramide, 8 of 9 given mexiletine and 4 of 5 given amiodarone. Sudden death did not occur in any of the 44 patients with successful antiarrhythmic treatment compared with a 39% incidence of sudden deaths in those with ventricular arrhythmias who were untreated (7 of 21) or had unsuccessful antiarrhythmic treatment (2 of 2) (p < 0.01). In conclusion, with aggressive antiarrhythmic treatment of ventricular arrhythmias, sudden death in postoperative tetralogy of Fallot has been significantly reduced.
↵b Dr. Garson is an Established Investigator of the American Heart Association, Dallas, Texas.
This study was supported in part by Grant HL07190 from the National Institutes of Health, United States Public Health Service, Washington, D.C., Grant RR00188 from the Department of Health and Human Services, United States Public Health Service and a grant from the J.S. Abercrombie Foundation, Houston, Texas.
- Received November 13, 1984.
- Revision received January 21, 1985.
- Accepted February 21, 1985.
- American College of Cardiology Foundation