van Huysduynen Bart Hooft, van Straten Alexander, Swenne Cees A, Maan Arie C, van Eck Henk J Ritsema, Schalij Martin J, van der Wall Ernst E, de Roos Albert, Hazekamp Mark G, Vliegen Hubert W
Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
Eur Heart J. 2005 May;26(9):928-32. doi: 10.1093/eurheartj/ehi140. Epub 2005 Feb 16.
Late after total correction, Fallot patients with a long QRS duration are prone to serious arrhythmias and sudden cardiac death. Pulmonary regurgitation is a common cause of right ventricular (RV) failure and QRS lengthening. We studied the effects of pulmonary valve replacement (PVR) on QRS duration and RV volume.
Twenty-six consecutive Fallot patients were evaluated both pre-operatively and 6-12 months post-operatively by cardiac magnetic resonance (CMR). In this study, we present the computer-assisted analysis of the standard 12-lead electrocardiograms closest in time to the CMR studies. For the whole group, QRS duration shortened by 6+/-8 ms, from 151+/-30 to 144+/-29 ms (P=0.002). QRS duration decreased in 18 of 26 patients by 10+/-6 ms, from 152+/-32 to 142+/-31 ms. QRS duration remained constant or increased slightly in eight of 26 patients by 3+/-3 ms, from 148+/-27 to 151+/-25 ms. CMR showed a decrease in RV end-diastolic volume from 305+/-87 to 210+/-62 mL (P=0.000004). QRS duration changes correlated with RV end-diastolic volume changes (r=0.54, P=0.01).
Our study shows that PVR reduces QRS duration. The amount of QRS reduction is related to the success of the operation, as expressed by the reduction in RV end-diastolic volume.
在完全矫正术后晚期，QRS波时限延长的法洛四联症患者易发生严重心律失常和心源性猝死。肺动脉反流是右心室（RV）衰竭和QRS波延长的常见原因。我们研究了肺动脉瓣置换术（PVR）对QRS波时限和右心室容积的影响。
连续26例法洛四联症患者在术前及术后6 - 12个月接受心脏磁共振成像（CMR）评估。在本研究中，我们展示了与CMR研究时间最接近的标准12导联心电图的计算机辅助分析。对于整个组，QRS波时限缩短了6±8毫秒，从151±30毫秒降至144±29毫秒（P = 0.002）。26例患者中有18例QRS波时限下降了10±6毫秒，从152±32毫秒降至142±31毫秒。26例患者中有8例QRS波时限保持不变或略有增加，增加了3±3毫秒，从148±27毫秒升至151±25毫秒。CMR显示右心室舒张末期容积从305±87毫升降至210±62毫升（P = 0.000004）。QRS波时限变化与右心室舒张末期容积变化相关（r = 0.54，P = 0.01）。
我们的研究表明PVR可缩短QRS波时限。QRS波缩短的程度与手术成功率相关，这可通过右心室舒张末期容积的减少来体现。
