The Role of Ablation in Prevention of Recurrent Implantable Cardioverter Defibrillator Shocks in Patients With Tetralogy of Fallot

Satoshi Kawada, Praloy Chakraborty, Eugene Downar, Andreu Porta Sanchez, Gnalini Sathananthan, Abhishek Bhaskaran, Priyanka Kugamoorthy, Lisa Albertini, Erwin N. Oechslin, Candice Silversides, Rachel M. Wald, Susan Lucy Roche, Lorna Swan, Rafael Alonso-Gonzalez, Sara Thorne, Louise Harris, Edward Hickey, Kumaraswamy Nanthakumar, Blandine Mondésert, Paul KhairyKrishnakumar Nair

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Implantable cardioverter defibrillators (ICDs) are effective in preventing arrhythmic sudden cardiac death in patients with tetralogy of Fallot (TOF). Although ICD therapies for malignant ventricular arrhythmias can be life-saving, shocks could have deleterious consequences. Substrate-based ablation therapy has become the standard of care to prevent recurrent ICD shocks in patients with ischemic cardiomyopathy. However, the efficacy and safety of this invasive therapy in the prevention of recurrent ICD shocks in patients with TOF has not been well evaluated. Methods: Records of a total of 47 consecutive TOF patients (mean age: 43.1 ± 13.2 years, male sex: n = 34 [72.3%]) who underwent ICD implantation for secondary prevention between 2000 and 2018 were reviewed. Results: Twenty (42.6%) patients underwent invasive therapy (radiofrequency catheter ablation, n = 8; surgical ablation with pulmonary valve replacement, n = 12) before ICD implantation. Twenty-seven patients (57.4%) were managed noninvasively. During follow-up (median 80.5 [interquartile range, 28.5-131.0] months), 2 (10.0%) patients in the invasive group and 10 (37.0%) patients in the noninvasive group received appropriate ICD shocks (P = 0.036). Logistic regression analysis showed that invasive therapy was associated with a decreased risk of ICD shocks by 81.1% (odds ratio, 0.189; 95% confidence interval, 0.036-0.990; P = 0.049). Furthermore, invasive therapy was associated with decreased risk of the composite outcomes of ICD shock, death, cardiac transplantation, and hospital admission (odds ratio, 0.090; 95% confidence interval, 0.025-0.365; P = 0.013) compared with noninvasive therapy. Conclusions: Invasive substrate modification therapy was associated with a lower likelihood of ICD shocks and improvement of long-term outcomes in TOF patients.

Original languageEnglish
Pages (from-to)619-626
Number of pages8
JournalCJC Open
Volume3
Issue number5
DOIs
Publication statusPublished - May 2021
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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