This protocol addresses the management of patients with Tetralogy of Fallot who present with sustained ventricular tachycardia and are scheduled for surgical pulmonary valve replacement or transcutaneous (percutaneous) valve insertion — a setting where both the arrhythmia and the planned valve procedure must be managed in a coordinated way.
Sustained ventricular tachycardia is the defining complication in this context. The patient is already indicated for surgical pulmonary valve replacement or transcutaneous valve insertion, and the presence of sustained VT calls for an integrated approach that addresses the arrhythmia substrate at the time of or around the valve intervention.
A catheter-based, pre-operative strategy targeting the anatomical substrate of the ventricular tachycardia is central to the recommended approach, timed in relation to the pulmonary valve procedure. The full protocol — including procedural sequence and technical details — is available via the link below.
DOI: 10.1093/eurheartj/ehaa554
In patients with sustained VT who are undergoing surgical PVRep or transcutaneous valve insertion, pre-operative catheter mapping and transsection of VT-related anatomical isthmuses before or during the intervention should be considered.
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