Among patients with Tetralogy of Fallot, the co-occurrence of multiple established risk factors for sudden cardiac death — including non-sustained symptomatic ventricular tachycardia alongside structural and electrophysiological markers — identifies a subset for whom a specific, evidence-based intervention is indicated.
Alternatively: unexplained syncope with impaired ventricular function and no reversible cause identified.
Current evidence supports a device-based approach to reduce the risk of arrhythmic sudden death in this population. The full selection criteria, procedural considerations, and patient pathway are detailed in the structured regimen.
DOI: 10.1093/eurheartj/ehaa554
ICD implantation should be considered in selected TOF patients with multiple risk factors for SCD, including LV dysfunction, non-sustained, symptomatic VT, QRS duration ≥180 ms, extensive RV scarring on CMR, or inducible VT at programmed electrical stimulation.
Patients with unexplained syncope and impaired ventricular function or other risk factors for SCD should undergo haemodynamic and EP evaluation.
In the absence of a reversible cause, ICD implantation should be considered.
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