Arrhythmias in Repaired Tetralogy of Fallot

Published: October 20, 2022

Close up of doctor attaching electrocardiograph sensors on boy chest while performing electrocardiogram test in clinic
  • Arrhythmia and sudden cardiac death remain common in repaired tetralogy of Fallot (rTOF) and affect even those with excellent anatomic repairs. Nonetheless, arrhythmias remain a major source of morbidity and mortality for adults with repaired TOF. This scientific statement explores the mechanisms for and treatment of atrial and ventricular arrhythmias in patients with rTOF.
  • The mechanisms of arrhythmia in patients with rTOF are often distinct from those in patients with acquired heart disease. Most arrhythmias in TOF result from macro-reentrant circuits, which are a consequence of both the underlying anatomy and the methods used for repair with considerable heterogeneity depending on the lesion severity and the era of repair.
  • Adult TOF patients have increased risk for developing reentrant atrial arrhythmias (AA), including intra-atrial reentrant tachycardia and cavo-tricuspid isthmus dependent atrial flutter (AFL). Cavo tricuspid isthmus dependent AFL and right atriotomy scar account for most of the intra-atrial reentrant tachycardia in TOF.