Outcomes After Late Reoperation in Patients With Repaired Tetralogy of Fallot: The Impact of Arrhythmia and Arrhythmia Surgery Tara Karamlou, MD, Ilana.

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Outcomes After Late Reoperation in Patients With Repaired Tetralogy of Fallot: The Impact of Arrhythmia and Arrhythmia Surgery Tara Karamlou, MD, Ilana Silber, BS, Robin Lao, BS, Brian W. McCrindle, MD, MPH, Louise Harris, MD, Eugene Downar, MD, Gary D. Webb, MD, Jack M. Colman, MD, Glen S. Van Arsdell, MD, William G. Williams, MD The Annals of Thoracic Surgery Volume 81, Issue 5, Pages 1786-1793 (May 2006) DOI: 10.1016/j.athoracsur.2005.12.039 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Intraoperative photo of electrophysiological mapping. The Annals of Thoracic Surgery 2006 81, 1786-1793DOI: (10.1016/j.athoracsur.2005.12.039) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Predicted overall survival from reoperation after repair of tetralogy of Fallot (ToF) stratified by the presence of arrhythmia at the time of reoperation. The two parametric curves are superimposed, indicating that survival was independent of arrhythmia status. Ten-year survival was 94% (70% confidence interval: 91% to 95%) for patients without arrhythmia (n = 174) and 93% (70% confidence interval: 89% to 96%) for those with arrhythmia (n = 75; p = 0.86. Solid lines represent parametric point estimates, and numbers along the horizontal axis represent the number of patients traced at that point. The Annals of Thoracic Surgery 2006 81, 1786-1793DOI: (10.1016/j.athoracsur.2005.12.039) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Flow chart showing the types of arrhythmia surgery performed in 59 patients. There were a total of 59 patients who had 65 ablative operations for arrhythmia performed. (RA = right atrial; SVT = supraventricular tachycardia; VT = ventricular tachycardia.) The Annals of Thoracic Surgery 2006 81, 1786-1793DOI: (10.1016/j.athoracsur.2005.12.039) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Time-related freedom from recurrent arrhythmia in 75 patients with arrhythmia at reoperation was characterized by a late hazard phase. Solid lines represent parametric point estimates enclosed by 70% confidence limits; circles with error bars represent nonparametric estimates; and numbers along the horizontal axis represent the number of patients traced at that point. (ToF = tetralogy of Fallot.) The Annals of Thoracic Surgery 2006 81, 1786-1793DOI: (10.1016/j.athoracsur.2005.12.039) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Kaplan-Meier estimated freedom from recurrent supraventricular tachycardia (SVT) stratified by whether an ablation occurred at the time of reoperation. There were 34 ablations and 9 nonablation episodes among the 41 patients with SVT. The 7.5-year survival free of recurrent arrhythmia is 75% for the ablated patients and 34% for those without (p < 0.001). Numbers along the horizontal axis represent the number of patients traced at that point. (ToF = tetralogy of Fallot.) The Annals of Thoracic Surgery 2006 81, 1786-1793DOI: (10.1016/j.athoracsur.2005.12.039) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Risk-adjusted nomogram generated from the multivariable equation for recurrent supraventricular tachycardia (SVT) depicts the predicted 10-year freedom from recurrent SVT (vertical axis) as a function of increasing QRS duration (horizontal axis) stratified by whether or not surgical ablation was performed at late reoperation. The risk of SVT is minimal until the QRS duration reaches 160 msec (inset), at which point the risk of recurrent SVT rises substantially. Importantly, surgical ablation abrogates, to a degree, the risk of recurrent SVT. Solid lines represent parametric point estimates enclosed by 70% confidence limits (dashed lines). The Annals of Thoracic Surgery 2006 81, 1786-1793DOI: (10.1016/j.athoracsur.2005.12.039) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions