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Predictors of Arrhythmia in Adults with Repaired Tetralogy of Fallot
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  • Jeffrey Moak,
  • Zachary E. Falk,
  • Annette M. Aldous,
  • Seiji Ito
Jeffrey Moak
Children's National Hospital

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Zachary E. Falk
The George Washington University School of Medicine and Health Sciences
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Annette M. Aldous
The George Washington University School of Medicine and Health Sciences
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Seiji Ito
Children's National Hospital
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Abstract

Introduction: Tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease in adults, has excellent long-term survival. However, many patients (30-45%) develop late arrhythmias. Previous studies have identified predictors of arrhythmia (atrial or ventricular) using clinical markers that predate arrhythmia onset for many years. Our objective was to develop predictive models for incident atrial arrhythmias or any arrhythmia (atrial and ventricular) within two years of clinical evaluation and diagnostic testing. Methods: A single-center retrospective cohort study of 188 adults with repaired TOF. We included only patients with results from ECG and echocardiogram data in the required time interval (3-24 months before first arrhythmia for cases; 24 months of follow-up for controls). Predictive multivariable models for risk of atrial arrhythmia using logistic regression with a least absolute shrinkage and selection operator (LASSO) penalty were developed. Results: Of 41 demographic, surgical, and diagnostic variables, six were selected as having predictive value for atrial arrhythmia based on cross validation. The factors with the greatest predictive value in decreasing order were moderate / severe tricuspid regurgitation (adjusted odds ratio (OR) 149.42), QRS fragmentation (OR 28.08), severe pulmonary regurgitation (OR 8.22), RV systolic dysfunction (OR 2.95), 1 st degree AV block, and age at time of surgical repair. Conclusion: Predictors for atrial or any arrhythmia in our study were similar, suggesting a common pathophysiologic substrate, i.e., abnormal right ventricle anatomical function and electrophysiologic properties (conduction and repolarization).