Aleligne Yeabsra, Eyvazian Vaughn A, Reardon Leigh, Aboulhosn Jamil, Moore Jeremy P, Lluri Gentian
David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
J Electrocardiol. 2019 May-Jun;54:36-39. doi: 10.1016/j.jelectrocard.2019.02.010. Epub 2019 Feb 27.
Chronic pulmonary regurgitation (PR) following surgical correction in Tetralogy of Fallot (TOF) leads to right ventricular (RV) dysfunction, arrhythmias and sudden cardiac death (SCD). Pulmonary valve replacement (PVR) decreases PR and improves RV function, but data regarding QRS duration reduction remain scarce.
All adult TOF patients undergoing transcatheter PVR or surgical PVR from 2010 to 2016 were included. Clinical characteristics and QRS duration were measured and compared to post-intervention QRS duration using an institutional software and manually verified. Significantly wide QRS was defined as QRS >140 ms.
Of 133 PVR patients, 85 had TOF and 27 (21.1%) had QRS > 140 ms (14 transcatheter, 13 surgical) and were included in this analysis. A 6 ms decrease in QRS duration was seen at 3-year follow-up (168.0 ± 3.5 ms vs. 161.8 ± 3.5 ms, p = .04). There was a significant decrease in the median RV size (defined as RV/LV diameter ratio) pre-intervention to 3-year post-intervention: (0.96 vs 0.89, p = .03). The median PR decreased significantly from moderate-severe to mild post-intervention (p < .0001).
Replacement of the pulmonary valve in high risk TOF patients reduces QRS duration at 3 years. Further study is needed to assess whether this QRS duration reduction may identify patients at lower risk of ventricular arrhythmias.
法洛四联症（TOF）手术矫正后出现的慢性肺动脉反流（PR）会导致右心室（RV）功能障碍、心律失常和心源性猝死（SCD）。肺动脉瓣置换术（PVR）可减少PR并改善RV功能，但关于QRS时限缩短的数据仍然很少。
纳入2010年至2016年期间接受经导管PVR或外科PVR的所有成年TOF患者。使用机构软件测量临床特征和QRS时限，并与干预后的QRS时限进行比较，并进行人工核对。显著增宽的QRS被定义为QRS>140毫秒。
在133例PVR患者中，85例患有TOF，27例（21.1%）的QRS>140毫秒（14例经导管，13例外科手术），并纳入本分析。在3年随访时，QRS时限缩短了6毫秒（168.0±3.5毫秒对161.8±3.5毫秒，p=0.04）。干预前至干预后3年，RV大小中位数（定义为RV/LV直径比）显著降低：（0.96对0.89，p=0.03）。干预后，PR中位数从中重度显著降至轻度（p<0.0001）。
高危TOF患者的肺动脉瓣置换术可在3年内缩短QRS时限。需要进一步研究以评估这种QRS时限缩短是否可识别室性心律失常风险较低的患者。
