Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
Cardiovascular Institute, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN, USA.
Pediatr Cardiol. 2023 Dec;44(8):1658-1666. doi: 10.1007/s00246-023-03272-0. Epub 2023 Aug 25.
The aim of this study is to analyze the relationship between QRS duration after pulmonary valve replacement (PVR) and ventricular arrhythmias (VA) in patients with repaired tetralogy of Fallot (ToF). ToF patients may face complications such as heart failure and VA after primary repair, often mitigated by PVR. Prior studies have shown a decrease in QRS duration and right ventricular (RV) size following PVR. It remains unclear whether a lack of QRS duration reduction identifies patients at risk of VA. We retrospectively identified adult patients with repaired ToF who underwent surgical or transcatheter PVR. EKG data (pre-PVR, 30 days to 1-year post-PVR, and closest to CMR) was collected. The primary endpoint was sustained ventricular tachycardia (VT), ICD shock for sustained VT, or inducible VT on EP study. 85 patients were included (median follow-up 3.6 years; median age 34 years; 51% females). The primary outcome was noted in 8 patients. Mean QRS duration decreased by 5 ms following PVR (p = 0.0001). Increased age at PVR, QRS ≥ 180 ms post-PVR, no reduction in QRS after PVR, and a history of VT were associated with higher risk of the primary endpoint. The change in QRS was linearly correlated with the change in RVEDVi (R = 0.66). Adults with repaired ToF experience a reduction in QRS duration post-PVR that correlates with the change of the RV size. Patients with QRS ≥ 180 ms post-PVR, no reduction in QRS, increased age at repair, and a history of VT are at risk for recurrent VT and warrant closer monitoring/ICD consideration.
本研究旨在分析肺动脉瓣置换术（PVR）后 QRS 时限与修复性法洛四联症（ToF）患者室性心律失常（VA）之间的关系。ToF 患者在初次修复后可能会出现心力衰竭和 VA 等并发症，这些并发症常可通过 PVR 缓解。既往研究表明，PVR 后 QRS 时限和右心室（RV）大小均减小。但尚不清楚 QRS 时限减少是否能识别出有 VA 风险的患者。我们回顾性地确定了接受过外科或经导管 PVR 的成年修复性 ToF 患者。收集心电图（PVR 前、PVR 后 30 天至 1 年和最接近 CMR 时）数据。主要终点是持续性室性心动过速（VT）、VT 导致 ICD 电击、或 EP 研究中可诱发 VT。共纳入 85 例患者（中位随访 3.6 年；中位年龄 34 岁；51%为女性）。8 例患者出现了主要结局。PVR 后 QRS 时限平均减少了 5ms（p=0.0001）。PVR 时年龄较大、PVR 后 QRS≥180ms、PVR 后 QRS 无减少以及 VT 病史与主要终点的风险增加相关。QRS 的变化与 RVEDVi 的变化呈线性相关（R=0.66）。修复性 ToF 患者在 PVR 后 QRS 时限缩短，与 RV 大小的变化相关。PVR 后 QRS≥180ms、QRS 无减少、修复时年龄较大以及 VT 病史的患者有发生复发性 VT 的风险，需要更密切的监测/ICD 考虑。
