Radiofrequency catheter ablation for ventricular tachycardia in tetralogy of fallot: A systematic review

Abstract

Background: Ventricular arrhythmias in adult patients following surgical repair of tetralogy of Fallot (TOF) may be challenging to manage and life-threatening. Ventricular tachycardia (VT) is the leading cause of sudden cardiac death in this patient population. Radiofrequency catheter ablation (RFCA) constitutes an important treatment modality for VT. Aim: The present study summarizes the outcomes of repaired TOF patients undergoing RFCA for resistant VT. Methods: A systematic literature search of the PubMed and Cochrane databases was performed with respect to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Eight studies including 106 patients were analyzed. Mean patient age at the time of RFCA was 39.0 ​± ​15.9 years, male:female ratio was 1.97:1. Programmed ventricular stimulation induced sustained VT in 81.6% (95%CI: 72.7–88.1) of patients. VT recurred shortly after the procedure in 16% (95%CI: 10.2–24.3) and during follow-up in 12.2% (95%CI: 6.3–21.7). The post-procedural use of amiodarone and beta-blockers therapy was decreased from 40% (95%CI: 30.3–51.1) to 20% (95%CI: 8.4–39.6) and from 58% (95%CI: 44.2–70.6) to 28% (95%CI: 14.1–47.8) of patients, respectively. A repeat RFCA procedure was required in 17.5% (95%CI: 11.1–26.4). No in-hospital deaths occurred, while overall mortality rate during a mean follow-up of 73.5 ​± ​61.4 months was 3% (95%CI: 0.2–10.9). Conclusion: RFCA can control ventricular dysrhythmias in over 80% of the cases, with zero in-hospital and low overall mortality, while substantially reducing the need for antiarrhythmic drugs.

Keywords

• Tetralogy of fallot
• Radiofrequency catheter ablation
• Ventricular arrhythmia
• Ventricular tachycardia