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Master Thesis

Intérêt de l’étude électrophysiologique avant remplacement valvulaire pulmonaire dans l’évaluation et la prise en charge du risque rythmique de la tétralogie de Fallot réparée

Abstract : Introduction. Patients with repaired tetralogy of Fallot (rToF) are currently exposed to late complications including requirement of pulmonary valve replacement (PVR) and risk of threatening macro-reentrant ventricular tachycardia (VT) involving anatomical isthmuses due to surgical scars. This work aims to study the clinical value of an invasive rhythmic evaluation before reoperation. Methods and Results. 37 patients (mean age 33.2 ± 16.5 years) with rTOF and indication of PVR were included once they agreed to undergo a preoperative electrophysiological study (EPS) with electro anatomical mapping of the right ventricle and ventricular programmed stimulation between 2010 and 2014. Eight patients (21.6%) were inducible (monomorphic sustained TV). Factors associated with arrythmogenic substrate determined by ventricle inducibility were: history of reoperation after repair (p=0.013), right ventricular dilatation severity assessed by end-systolic volume (p=0.039), impaired right ventricular ejection fraction (p=0.034), history of unsustained VT (p=0.026) as well as slower conduction velocity (p=0.037) and presence of local abnormal ventricular activities (p=0.038) for the isthmus between pulmonary annulus and septal patch which was predominantly involved. EPS changed management for 13 patients (35.1%) with 9 ventricular catheter ablations, 11 surgical cryoablations and 2 indications for implantable cardioverter defibrillator. During 38.8 ± 14.8 months of follow-up, two episodes of VT (one recurrence after ablation; one inaugural arrhythmia probably of focal mechanism) and a death related to heart failure occurred. Conclusion. Preoperative EPS can improve the assessment of ventricular arrythmia risk through determination of the arrhythmogenic substrate and then lead to an individualised prophylactic management at the time of PVR.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01246409
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Submitted on : Friday, December 18, 2015 - 2:53:03 PM
Last modification on : Wednesday, August 23, 2017 - 4:32:42 PM
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Mathieu Courtheix. Intérêt de l’étude électrophysiologique avant remplacement valvulaire pulmonaire dans l’évaluation et la prise en charge du risque rythmique de la tétralogie de Fallot réparée. Médecine humaine et pathologie. 2015. ⟨dumas-01246409⟩

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