Long-Term Arrhythmic Complications in Patients with Repaired Tetralogy of Fallot: A Single-Center Experience from...

Advances in surgical techniques have substantially improved survival in patients with repaired tetralogy of Fallot (ToF). However, residual lesions following repair may lead to long-term complications, including arrhythmias and the need for device therapy. We conducted a retrospective single-center cohort study including patients who underwent surgical repair of ToF between 1960 and the present. Patients were categorized into three treatment eras (<1980, 1980-2000, >2000). Data on surgical strategy, mortality, arrhythmias, and cardiac implantable electronic device (CIED) implantation were collected from institutional databases. A total of 640 patients were included, of whom 360 (56.3%) underwent transannular patch (TAP) repair and 280 (43.7%) underwent non-TAP repair. Overall mortality was 7.2%, with cardiac causes accounting for 41.3% of deaths. Arrhythmias occurred in 14.4% of patients and were more frequently observed in those who underwent TAP repair (18.8%). CIED implantation was required in 7.5% of patients, most commonly implantable cardioverter defibrillators. The incidence of arrhythmias decreased across treatment eras, whereas overall survival did not differ significantly between eras. Long-term survival after surgical repair of ToF is favorable. Arrhythmias remain an important late complication, particularly in patients who underwent TAP repair, although their frequency appears to have decreased in more recent treatment eras. These findings underscore the long-term impact of initial surgical strategy on arrhythmic outcomes.