Predictors and Prognostic Value of Arrhythmia Post Fallot Repair

Abstract Background: Tetralogy of Fallot is a congenital cardiac malformation that occurs in 3 of every 10,000 live births, and accounts for 7-10% of all congenital cardiac malformations. Arrhythmia contributes to both morbidity and mortality in patients with repaired TOF. Atrial tachyarrhythmias are prev-alent and are associated with increased morbidity. Preventing sudden death remains one of the largest challenges in the care of patients with CHD. Although there has been progress in noninvasive and invasive risk stratification, there remains no widely accepted algorithm to identify patients who are at greatest risk of arrhythmia and warrant more aggressive treatment. Aim of Study: To characterize patients with risk of arrhyth-mia (SVT or Junctional), identify its predictors and prognosis in selected TOF patients undergoing total repair at Ain Shams University, Cardiothoracic Department. Patients and Methods: It is a prospective observational study on 65 pediatric patients who underwent total correction of TOF, conducted at Ain Shams University Hospitals, Cardi-othoracic Department. Preoperative, intra operative, and post operative variables were assessed including patients' age at the time of surgery, gender, weight (Kg), preoperative ECHO, MSCT, the use of inotropic supports, 12-lead ECG, data of postoperative ECHO including (residual VSD, RV function (RVSP & TAPSE), associated valve disorders, pulmonary annulus size, RVOT gradient, pulmonary arteries sizes). Results: Results of the current study indicated no direct relationships between the occurrence of JET and gender, weight, level of preoperative oxygen saturation, percentage of cyanotic spells, ECHO hemodynamic parameters (VSD size, RVOT gradient, associated valve disorders, pulmonary arteries sizes and McGoon index), CPB, CCT, cardioplegia type, approach, use of TAP, VSD closure technique, use of RVOT patch, previous shunt, intra-op temperature, and the type of inotropic support used. Nonetheless, there were a significant relationship between younger age of operation and lower pulmonary annulus size with the occurrence of JET. Conclusion: Cardiac arrhythmias are a frequent problem in the early post operative course after cardiac surgery. Junctional ectopic tachycardia is a frequent complication after Tetralogy of Fallot repair. It has a benign course; however, it possesses a negative impact on ICU and hospital stay. In this study, we identified factors associated with the occurrence of arrhythmias in the postoperative period.