Fewer Arrhythmias With Late Pulmonary Valve Replacement in Tetralogy of Fallot

There is increased risk for ventricular arrhythmias in patients with Tetralogy of Fallot that have not received pulmonary valve replacement.

There is a significantly higher rate of ventricular arrhythmias in patients with Tetralogy of Fallot (TOF) who never received pulmonary valve replacement (PVR), compared with patients who had late PVR. Patients with late PVR after TOF repair also have a lower mortality rate, according to study results presented at the American College of Cardiology (ACC) 2023 conference, held from March 4 to 6, 2023, in New Orleans, Louisiana.

Investigators sought to assess when patients with TOF should receive PVR and PVR’s impact on the development of subsequent ventricular tachycardias.

They conducted a meta-analysis that included 12 studies (N=1740) with patients with concomitant TOF and the development of ventricular arrhythmias following initial repair. The investigators aimed to compare patients with TOF who received late PVR after initial repair vs patients with no further intervention. The effect of age and time to PVR on incidence of ventricular arrhythmias was assessed with meta-regression analysis.

The investigators found almost 60% lower cumulative incidence of ventricular arrhythmias in patients with late PVR vs patients without PVR (odds ratio, 0.40; 95% CI, 0.22-0.73; P <.003) among patients with TOF. There were similar results in random and fixed effect models.

There was a significant reduction in difference in means of right ventricular end-diastolic volume (RV-EDV) after PVR (random-effects model: -1.44; standard error, 0.188; P <.0001). Following late PVR, patients with a reduction in RV-EDV experienced significant reduction in ventricular arrhythmia frequency.

Using metaregression, the investigators noted statistically significant coefficients for changes relative to preoperative RV-EDV in postoperative RV ejection fraction and postoperative quality rating system (QRS) but not for ventricular tachycardia. They noted relative to preoperative QRS, statistically significant coefficients for changes in postoperative RV-EDV and postoperative RV ejection fraction, but not for incidence of ventricular tachycardia.

“For patients with TOF and survival after repair, there was a markedly higher rate of ventricular arrhythmias in patients who never received PVR compared to patients who had late PVR,” the investigators wrote.

This article originally appeared on The Cardiology Advisor.


Khalid Y, Dasu N, Dasu K, et al. The impact of late pulmonic valve replacement on ventricular arrhythmias associated with tetralogy of Fallot (TOF) in adults. Abstract presented at: ACC 2023; March 4-6, 2023; New Orleans, LA. Abstract 1052-07.