Biventricular Simulation Pipeline for Risk Stratification in Repaired Tetralogy of Fallot

Tetralogy of Fallot is the most common cyanotic congenital heart disease. The ma- jority of patients survive into adulthood but most experience adverse cardiac events before the age of fifty. Effective risk stratification to identify the most vulnerable patients before an adverse event occurs remains a clinical challenge. Post-corrective surgery anatomy combined with age-related remodelling may lead to the formation of anatomic isthmuses. Conduction slowing within one or more of these isthmuses has been shown to be a cause of inducible ventricular tachycardia, one of the most predictive risk factors for this cohort of patients. Based on these observations, a meshing and simulation pipeline was developed to non-invasively assess vulnerabil- ity to reentry using conduction slowing within an isthmus. Simulation showed that reentry vulnerability increased as conduction velocity within the isthmus decreased. The pipeline was able to assess reentry risk even without induction. This pipeline may be developed and clinically validated to be used as a patient-specific method for assessing post-repair tetralogy of Fallot patients in adulthood.