Oosterhof Thomas, Vliegen Hubert W, Meijboom Folkert J, Zwinderman Aeilko H, Bouma Berto, Mulder Barbara J M
Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
Heart. 2007 Apr;93(4):506-9. doi: 10.1136/hrt.2006.094169. Epub 2006 Oct 25.
To analyse the long-term course of QRS duration after pulmonary valve replacement in patients with a previous correction for tetralogy of Fallot.
Tertiary referral centres.
In a retrospective study, 99 adult patients with tetralogy of Fallot, who had undergone a first pulmonary valve replacement late after initial total correction, were identified from the CONCOR (CONgenital CORvitia) registry. Computer-generated QRS durations were obtained from 12-lead electrocardiogram ECG reports in the medical records. A mixed linear regression model was used to analyse the course of QRS duration over time and to identify risk factors for increase in QRS duration over time. Composite end point was created from sudden cardiac death, ventricular tachycardia or implantable cardioverter-defibrillator discharge.
In total, 99 patients (57% men, mean (SD) age at pulmonary valve replacement 29 (11) years) with a median follow-up of 4.9 (0.1-16) years were analysed. In patients with preoperative QRS <120 ms, surgery caused no significant change in QRS duration (increase 1.3 (7.9) ms; p = 0.65), and after surgery, QRS duration remained stable over time (increase 0.0064 (0.059) ms/year; p = 0.98). By contrast, in patients with a preoperative QRS of 150-180 ms or QRS > or =180 ms, surgery resulted in QRS shortening (mean decrease 9.9 (SE 4.3) ms, p = 0.021, and 12.2 (SE 2) ms; p<0.001, respectively). During follow-up, a QRS widening 1.1(1.3) ms/year (p<0.001) in both groups was observed. In patients with a preoperative QRS > or =180 ms, no significant difference was observed in the number of patients reaching the composite end point compared with patients with a preoperative QRS of 150-180 ms (25% vs 7%; p = 0.08). However, the former more often reached QRS > or =180 ms again after surgery compared with the latter (53% vs 13%; p = 0.02, respectively). None of the patients with a preoperative QRS > or =180 ms died during follow-up.
In our study, we observed a decrease in QRS duration directly after surgery, followed by a steady increase, in patients with a preoperative QRS >150 ms. The beneficial effect of pulmonary valve replacement on QRS duration was transient. The risk of developing ventricular arrhythmias after surgery was substantial when preoperative QRS was > or =180 ms, but mortality remained low.
分析法洛四联症患者先前接受矫治后行肺动脉瓣置换术后QRS时限的长期变化过程。
三级转诊中心。
在一项回顾性研究中，从CONCOR（先天性心脏病队列研究）注册库中识别出99例法洛四联症成年患者，这些患者在初次完全矫治后晚期接受了首次肺动脉瓣置换术。通过计算机从病历中的12导联心电图（ECG）报告获取QRS时限。采用混合线性回归模型分析QRS时限随时间的变化过程，并确定QRS时限随时间增加的危险因素。复合终点由心源性猝死、室性心动过速或植入式心律转复除颤器放电构成。
共分析了99例患者（男性占57%，肺动脉瓣置换时的平均（标准差）年龄为29（11）岁），中位随访时间为4.9（0.1 - 16）年。术前QRS<120 ms的患者，手术未导致QRS时限显著变化（增加1.3（7.9）ms；p = 0.65），术后QRS时限随时间保持稳定（每年增加0.0064（0.059）ms；p = 0.98）。相比之下，术前QRS为150 - 180 ms或QRS≥180 ms的患者，手术导致QRS时限缩短（平均分别减少9.9（标准误4.3）ms，p = 0.021，以及12.2（标准误2）ms；p<0.001）。随访期间，两组均观察到QRS时限以每年1.1（1.3）ms的速度增宽（p<0.001）。术前QRS≥180 ms的患者与术前QRS为150 - 180 ms的患者相比，达到复合终点的患者数量无显著差异（25%对7%；p = 0.08）。然而，与后者相比，前者术后更常再次出现QRS≥180 ms（分别为53%对13%；p = 0.02）。术前QRS≥180 ms的患者在随访期间均未死亡。
在我们的研究中，我们观察到术前QRS>150 ms的患者术后QRS时限立即缩短，随后稳步增加。肺动脉瓣置换对QRS时限的有益作用是短暂的。术前QRS≥180 ms时，术后发生室性心律失常的风险很大，但死亡率仍然很低。
