Volume 11, Issue 10, Pages (October 2014)

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Volume 11, Issue 10, Pages 1735-1742 (October 2014) Sudden death in adult congenital heart disease: Risk stratification in 2014 Edward P. Walsh, MD, FHRS Heart Rhythm Volume 11, Issue 10, Pages 1735-1742 (October 2014) DOI: 10.1016/j.hrthm.2014.07.021 Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 1 Pathologic specimen from a young patient with unrepaired tetralogy of Fallot demonstrating the intrinsic anatomic features that can contribute to macroreentrant ventricular tachycardia. A portion of the anterior right ventricle (RV) has been removed to expose the ventricular septal defect (VSD), the stenotic pulmonary outflow tract (PA), and the narrow band of muscle (Conal Septum) running between the VSD and the PA. The 3 curved arrows mark locations that could function as protected corridors supporting macroreentry after surgical repair. Heart Rhythm 2014 11, 1735-1742DOI: (10.1016/j.hrthm.2014.07.021) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 2 Electroanatomic maps of the right atrium demonstrating atrial macroreentry that developed in an adult with tetralogy of Fallot many years after surgical repair. Surgery included a right lateral atriotomy incision (hatched area). A: Typical counterclockwise macroreentry around the tricuspid valve (TV) through the cavotricuspid isthmus. B: Second macroreentry circuit on the lateral atrial wall that used the atriotomy scar as the central obstacle and traveled through a narrow gap between the lower edge of the scar and the inferior vena cava (IVC). Heart Rhythm 2014 11, 1735-1742DOI: (10.1016/j.hrthm.2014.07.021) Copyright © 2014 Heart Rhythm Society Terms and Conditions