VT Prevention in Repaired Tetralogy of Fallot: Mapping SCAI and Minimizing ICDs | JACC Baran

VT Prevention in Repaired Tetralogy of Fallot: Mapping SCAI and Minimizing ICDs | JACC Baran

Author: American College of Cardiology May 20, 2025 Duration: 35:36

Hosts Mitsuaki Sawano, MD, and Nobuhiro Ikemura, MD, welcome Yoshitaka Kimura, MD, PhD, of Leiden University Medical Center, to discuss proactive ablation strategies in patients with repaired Tetralogy of Fallot (rTOF). Dr. Kimura presents data from a long-term, single-center study evaluating electroanatomical mapping and preventive ablation of slow-conducting anatomical isthmuses (SCAI) in rTOF patients without prior ventricular tachycardia (VT). The findings show that identifying and successfully ablating SCAI significantly reduced VT incidence, with all VT events occurring in patients where ablation failed. Moreover, this approach reduced the proportion of patients qualifying for ICD implantation from 25–51% under current guidelines to just 11%. Dr. Kimura underscores a paradigm shift in congenital heart disease management—from treating VT reactively to preventing it proactively—highlighting the value of data-driven, tailored care strategies that avoid unnecessary device implantation and better target high-risk individuals.


Every week, the editors of one of the world's leading cardiology journals sit down for a conversation that goes beyond the printed page. JACC This Week, from the American College of Cardiology, brings together Editor-in-Chief Dr. Harlan Krumholz and Senior Consulting Editor Dr. Carolyn S.P. Lam. Their discussions provide essential context for the complex research published in the Journal of the American College of Cardiology, translating high-level science into meaningful insights. You’ll hear them dissect new studies, debate emerging trends, and explore the real-world implications of the latest findings in cardiovascular medicine. This isn't just a summary of the issues; it's a dialogue about how evidence is shaping modern heart care, from prevention to advanced intervention. The podcast serves as a direct line to the experts who are curating the science that defines global standards. Each episode feels like joining an informed, behind-the-scenes editorial meeting, where the nuances of patient care and clinical practice are thoughtfully examined. For anyone invested in cardiology-whether a practicing clinician, a researcher, or a dedicated student-this regular audio companion offers clarity and a deeper understanding of the forces driving the field forward. It’s where the published data meets practical conversation, all through the accessible format of a weekly podcast.
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