Clinical Characteristics of Patients with Tetralogy of Fallot who Underwent an Invasive Procedure for Arrhythmias

Introduction: Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that has an incidence of sudden cardiac death of 0.2% per year, being arrhythmias the main cause of its occurrence. Objective: To compare characteristics of TOF patients referred for electrophysiological study (EPS) against those that were not (No-EPS). Method: Retrospective cohort with 215 patients (57.2% men; age = 29 ± 4) with corrected TOF (median of three years, ranging from 0.33 to 51) that underwent EPS between 2009-2020. The primary outcome was composed of death, implantable cardiac defibrillator (ICD) requirement and hospitalization. Results: Pre-syncope (EPS = 4.7%, No-EPS = 0%; p = 0.004), syncope (EPS = 7.1%, No-EPS = 1.7%; p = 0.056) and palpitations (EPS = 31%, No-EPS = 5.8%; p < 0.001) were symptoms that justified electrophysiological investigation. ICD was implanted in 24% of EPS and 0.6% of No-EPS (p=0.001). Twenty-six percent of the EPS group presented non-sustained ventricular tachycardia, while 0% in No-EPS (p = 0.012). The EPS group had more atrial fibrillation or atrial Flutter (35.7% vs. 6.9%; p < 0.001). The EPS patients had a wider QRS duration than the no-EPS group (171.12 ± 29.52 ms vs. 147 ± 29.77 ms; p < 0.001). Also, 26.2% of EPS performed ablation to correct macroreentrant atrial tachycardias. The incidence of primary outcome (death + ICD requirement + hospitalization) was higher in patients in the EPS group compared to the No-EPS group (p = 0.001). However, the total of seven deaths occurred during the clinical follow-up, but without differences between the groups (EPS = 4.7% vs. No-EPS = 2.8%; p = 0.480). Conclusion: EPS group had a profile of greater risk, more complex heart disease, and a greater occurrence of the primary outcome when compared to the No-EPS group.

Physical Activity and Incidence of Atrial Fibrillation - Systematic Review and Meta-Analysis

The relationship between exercise and atrial fibrillation (AF) is controversial. Objectives: To analyze the effects of physical activity on the incidence of atrial fibrillation using systematic review and meta-analysis. Methods: Systematic review and meta-analysis of studies that relate physical exercise and atrial fibrillation. The following databases were searched: PubMed, BVS Saúde and Cochrane. The following descriptors were used: "atrial fibrillation", "exercise", "physical activity" and "exercise therapy". All prospective, retrospective, cross-sectional and cohort studies were investigated. All statistical analyzes were provided using Review Manager 5.3 to provide the mean difference (MD) and relative risk (RR) ratio with 95% confidence intervals (95% CI). The statistical method of heterogeneity index was used to assess heterogeneity. Level of significance was 5%. Results: Combined analysis of 11 studies totaling 276,323 participants aged between 12 and 90 years did not suggest a significant increase in AF in individuals submitted to physical exercise (RR = 0.914, 95% CI = 0.833-1.003, heterogeneity: p < 0.001). Conclusions: Physical exercise, lato sensu, without stratification by intensity, sex or age does not seem to be associated with an increase of atrial fibrillation