More recently, Ghonim et al expanded on the predictors of all-cause mortality in rTOF, creating a risk score with inclusion of LGE of the RV and left ventricle in addition to CMR measures of systolic function, exercise parameters, BNP, age, and history of arrhythmia.4 Worthy of mention is the weighting of the Ghonim scoring system toward presence of LGE with 40 of the 100 available points assigned in the presence of severe RV LGE rendering this variable the strongest predictor of outcome. Here, NPPB is linked to cardiac arrhythmia.