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. 2021 Oct;42(7):1488-1495.
doi: 10.1007/s00246-021-02632-y. Epub 2021 May 7.

QRS Duration During Follow-Up of Tetralogy of Fallot: How Valuable is it? Analysis of ECG Changes in Relation to Pulmonary Valve Implantation

Thomas Martens  1 , Katrien François  2 , Hans De Wilde  3 , Laurence Campens  4 , Laurent Demulier  4 , Julie De Backer  4 , Daniel Dewolf  3 , Thierry Bove  2
Affiliations

QRS Duration During Follow-Up of Tetralogy of Fallot: How Valuable is it? Analysis of ECG Changes in Relation to Pulmonary Valve Implantation

Thomas Martens et al. Pediatr Cardiol. 2021 Oct.

Abstract

Long-term results after tetralogy of Fallot (TOF) repair are determined by the extent of right ventricular remodeling to chronic pulmonary regurgitation entailing progressive RV dysfunction and a risk of developing ventricular arrhythmia. Pulmonary valve replacement (PVR) can alleviate this burden. As a predictor of ventricular arrhythmia, QRS duration remains a strong parameter in this decision. We performed a retrospective analysis of all PVR patients between 2005 and 2018, studying the time evolution of electrocardiographic parameters before and after PVR through linear mixed model analysis. 42 TOF patients underwent PVR. The median timespan between primary repair and PVR was 18 years (IQR 13-30). The indication for PVR was primarily based on the association of exercise intolerance (67%) and significant RV dilation on cMRI (median RVEDVi 161 ml/m2 IQR 133-181). Median QRS length was 155 ms (IQR 138-164), 4 (10%) patients had a QRS > 180 ms. QRS duration increased significantly before PVR, but barely showed regression after PVR. Changes of QRS duration after PVR were independent of RV dilation. In conclusion, when the decision for PVR in TOF patients is primarily based on RV volume and/or function threshold, QRS duration > 180 ms is rarely observed. In contrast with the significant increase of QRS duration before PVR, QRS length regression appears to be independent of the extent of RV dilation or QRS > 160 ms. Considering that the decision for PVR is based on mechanical RV characteristics, the utility of serial follow-up of QRS duration in contemporary operated TOF patients becomes questionable in absence of clinical arguments for ventricular arrhythmia.

Keywords: Electrocardiography; Pulmonary valve replacement; Right ventricle; Tetralogy of Fallot.

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References

    1. Smith CA, McCracken C, Thomas AS, Spector LG, St Louis JD, Oster ME et al (2019) Long-term outcomes of tetralogy of fallot: a study from the pediatric cardiac care consortium. JAMA Cardiol 4(1):34–41. https://doi.org/10.1001/jamacardio.2018.4255 - DOI - PubMed
    1. Padalino MA, Pradegan N, Azzolina D, Galletti L, Pace Napoleone C, Agati S et al (2020) The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study. Eur J Cardio-Thorac Surg 57(3):565–573. https://doi.org/10.1093/ejcts/ezz270 - DOI
    1. Maury P, Sacher F, Rollin A, Mondoly P, Duparc A, Zeppenfeld K et al (2017) Ventricular arrhythmias and sudden death in tetralogy of Fallot. Arch Cardiovasc Dis 110(5):354–362. https://doi.org/10.1016/j.acvd.2016.12.006 - DOI - PubMed
    1. Hazan E, Bical O, Bex JP, Dubuis C, Lecompte Y, De Riberolles C et al (1980) Is right bundle branch block aviodable in surgical correction of tetralogy of Fallot? Circulation 62(4):852–854. https://doi.org/10.1161/01.cir.62.4.852 - DOI - PubMed
    1. Davlouros PA, Kilner PJ, Hornung TS, Li W, Francis JM, Moon JC et al (2002) Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 40(11):2044–2052. https://doi.org/10.1016/s0735-1097(02)02566-4 - DOI - PubMed

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