Ventricular arrhythmias immediately following transcatheter pulmonary valve implantation: A cause for concern?

Catheter Cardiovasc Interv. 2018 Apr 1;91(5):920-926. doi: 10.1002/ccd.27454. Epub 2017 Dec 27.

Abstract

Background: Transcatheter pulmonary valve implantation (TPVI) has revolutionized the care of patients with congenital disorders of the right ventricular outflow tract (RVOT) and is increasingly being used in patients with native outflow tracts. This is the first study to specifically report the occurrence of ventricular arrhythmias in the immediate post-TPVI period.

Methods and results: Medical records of all adult and pediatric patients who underwent TPVI at our institution between May 1, 2011 and March 1, 2016, were reviewed for the presence of clinically significant ventricular arrhythmias occurring within 30 days of TPVI. We defined a clinically significant arrhythmia as any ventricular arrhythmia that led to hemodynamic instability, resulted in a change of dose or addition of a new anti-arrhythmic medication, caused a delay in discharge, or was the primary reason for readmission. Seventy-five patients, with a median age of 19 years (range 4-65 years), underwent TPVI. In total, 12 (16%) patients had a clinically significant ventricular arrhythmia within 30 days following TPVI. Patients with native outflow tracts were at higher risk of post-TPVI arrhythmias than non-native outflow tract (29% vs. 9%, P = 0.02, adjusted OR 4.8, 95%CI 1.2-20.2). There were no cases of hemodynamic compromise or sudden cardiac death. The arrhythmias were well controlled with beta-blocker therapy.

Conclusion: In this single center study, ventricular arrhythmias were common following TPVI, particularly in native outflow tract patients. However, the arrhythmias were generally benign and responded well to medical therapy when indicated. Long term therapy was often not needed.

Keywords: adults congenital heart disease; pediatric catheterization/intervention complications; pediatrics congenital heart disease; percutaneous intervention; pulmonary valve disease.

MeSH terms

  • Adolescent
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aged
  • Anti-Arrhythmia Agents / therapeutic use
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / drug therapy
  • Arrhythmias, Cardiac / etiology*
  • Arrhythmias, Cardiac / physiopathology
  • Catheterization, Swan-Ganz / adverse effects*
  • Catheterization, Swan-Ganz / methods
  • Child
  • Child, Preschool
  • Female
  • Heart Rate* / drug effects
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / methods
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Valve / diagnostic imaging
  • Pulmonary Valve / physiopathology
  • Pulmonary Valve / surgery*
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Adrenergic beta-Antagonists
  • Anti-Arrhythmia Agents