ECG, the old kid around the block who betrays conduction secrets in patients with tetralogy of Fallot

Over the past years, patients with Tetralogy of Fallot (TOF) have experienced numerous improvements in different treatment modalities consisting of a mixture of surgical procedures, transcatheter interventions including ablation therapy, and ICD implantations. However, progress in these therapeutic options have also introduced novel clinical hurdles. While both surgical and transcatheter pulmonary valve replacement (PVR) improve the hemodynamic status of TOF patients, they potentially hamper access to anatomical isthmuses involved in reentrant circuits underlying ventricular tachycardias (VT). 1 Combes N. Bartoletti S. Heitz F. Waldmann V. Critical isthmus of ventricular tachycardia covered by transcatheter pulmonary valve in a patient with tetralogy of Fallot. Eur Heart J Feb 1. 2020; 41723 Google Scholar This has led to an interest in performing electrophysiological studies (EPS) before PVR in order to identify and transect latent isthmuses, thereby preventing development of post-operative VT and hence potentially also sudden cardiac death. 2 Moore J.P. Aboulhosn J.A. Khairy P. Electrophysiology testing before transcatheter pulmonary valve replacement in patients with repaired tetralogy of Fallot. Eur Heart J. Aug 8 2023; Crossref Google Scholar Sinus rhythm QRS morphology reflects right ventricular activation and anatomical ventricular tachycardia isthmus conduction in repaired tetralogy of FallotHeart RhythmPreviewPatients with repaired tetralogy of Fallot (TOF) are at risk for ventricular tachycardia (VT) related to well-described anatomical isthmuses. Full-Text PDF