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. 2023 Jan 29:10.1002/ccd.30560.
doi: 10.1002/ccd.30560. Online ahead of print.

Ventricular arrhythmias following balloon-expandable transcatheter pulmonary valve replacement in the native right ventricular outflow tract

Spencer B Barfuss  1 , Juan Carlos Samayoa  2 , Susan P Etheridge  1 , Thomas A Pilcher  1 , Sarah Yukiko Asaki  1 , Zhining Ou  3 , Dana M Boucek  1 , Mary Hunt Martin  1 , Robert G Gray  1 , Mary C Niu  1
Affiliations

Ventricular arrhythmias following balloon-expandable transcatheter pulmonary valve replacement in the native right ventricular outflow tract

Spencer B Barfuss et al. Catheter Cardiovasc Interv. .

Abstract

Background: Ventricular arrhythmia incidence in children and adolescents undergoing transcatheter pulmonary valve replacement (TPVR) within the native right ventricular outflow tract (nRVOT) is unknown. We sought to describe the incidence, severity, and duration of ventricular arrhythmias and identify associated risk factors in this population.

Methods: This was a retrospective cohort study of 78 patients <21 years of age who underwent TPVR within the nRVOT. Patients were excluded for pre-existing ventricular arrhythmia or antiarrhythmic use. Study variables included surgical history, valve replacement indication, valve type/size, and ventricular arrhythmia. Univariable logistic regression models were used to evaluate factors associated with ventricular arrhythmias, followed by subset analyses.

Results: Nonsustained ventricular arrhythmia occurred in 26/78 patients (33.3%). The median age at the procedure was 10.3 years (interquartle range [IQR]: 6.5, 12.8). Compared with other nRVOT types, surgical repair with transannular patch was protective against ventricular arrhythmia incidence: odds ratio (OR): 0.35 (95% confidence interval [CI], 0.13-0.95). Patient weight, valve type/size, number of prestents, and degree of stent extension into the RVOT were not associated with ventricular arrhythmia occurrence. Beta blocker was started in 16/26 (61.5%) patients with ventricular arrhythmia. One additional patient was lost to follow-up. The median beta blocker duration was 46 days (IQR 42, 102). Beta blocker was discontinued in 10 patients by 8-week follow-up and in the remaining four by 9 months.

Conclusions: Though common after balloon-expandable TPVR within the nRVOT, ventricular arrhythmias were benign and transient. Antiarrhythmic medications were successfully discontinued in the majority at 6- to 8-week follow-up, and in all patients by 20 months.

Keywords: adult congenital heart disease; congenital heart disease; transcatheter pulmonary valve replacement; ventricular arrhythmia.

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Conflict of interest statement

Disclosures:

The authors of this study have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Patient Eligibility and Inclusion Flow Chart
Figure 2:
Figure 2:
Ventricular Arrhythmias by Type NSVT = non-sustained ventricular tachycardia; PVCs = premature ventricular contractions; AVR = accelerated ventricular rhythm
Figure 3:
Figure 3:
Patients Receiving Treatment for Post-Procedure Ventricular Arrhythmias by Time Percentage of patients receiving pharmacologic treatment for ventricular arrhythmias as a function of time since TPVR. The 6-week endpoint is highlighted by the red box. The blue line represents patients remaining on treatment from the time of valve implantation. The orange line represents patients for whom therapy was resumed due to persistent arrhythmia after discontinuation.
Figure 4:
Figure 4:
Suggested Management Algorithm for Clinically Significant Ventricular Arrhythmias VA = ventricular arrhythmia *Patients are monitored on telemetry to assure at least 12 hours without NSVT following beta blocker initiation.
None
See this image and copyright information in PMC

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