Arrhythmogenic substrate in young patients with repaired tetralogy of Fallot: Role of an abnormal ventricular repolarization

Sarubbi, Berardo; Pacileo, Giuseppe; Ducceschi, Valentino; Russo, Maria Giovanna; Iacono, Carola; Pisacane, Carlo; Iacono, A; Calabrò, Raffaele

doi:10.1016/s0167-5273(99)00166-7

Cited by 28 publications

(30 citation statements)

References 58 publications

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“…For the total correction in TOF, RVOT reconstruction and ventricular septal defect repair are both required. When considering ventricular arrhythmia in repaired TOF, RVOT lesions including transannular patch and PR and electrical factors as QRS prolongation are considered to be most important factors (1,3,4,18,19,21). In the long-term follow-up data of repaired ventricular septal defect patients, we did not find significant increment of ventricular arrhythmia events and late cardiac deaths (26).…”

Section: Discussionmentioning

confidence: 56%

“…The hemodynamic risk factors include PR, right ventricle outflow transannular patch, increased right ventricle systolic pressure, and older age at operation. The electrophysiologic risk factors include prolonged QRS duration, increased JTc interval, QRS dispersions, and QT dispersions (3,4,18). Gatzoulis et al (5,20,21) proposed that electromechanical interaction of the above risk factors [i.e.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Chiu

Huang

Chang³

et al. 2011

Pediatr Res

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Pulmonary regurgitation and prolonged QRS duration of right bundle branch (RBB) block are common in repaired tetralogy of Fallot (TOF) and increase the risk of sudden death. We sought to establish an animal model to reflect both abnormalities. Twenty-one canines: group I (n ϭ 7) received a surgical right ventricular outflow tract (RVOT) transannular patch plus pulmonary valve destruction; group II (n ϭ 5) received RBB ablation and sham operation; and group III (n ϭ 9) received combined interventions. Serial electrophysiological data were obtained up to 1 y. Procedure mortality was 27.6%. At 1 y, although severe pulmonary regurgitation was documented in most dogs in groups I (71%) and III (100%), progressive RVOT dilatation was noted in group III. RBB block was present in all dogs in groups II and III. However, the increments of QRS duration, QTc, JTc, and QT dispersion progression between 1 mo and 1 y were all greatest in group III. Ventricular arrhythmia events were frequent in group III (median 3.3/mo) but uncommon in groups I and II (median 1/mo). We have created a novel animal model that adequately reflects both the hemodynamic and electrophysiological characteristics of repaired TOF patients and can be applied to examine the risk of ventricular arrhythmias. (Pediatr Res 70: 247-252, 2011) W ith the advances in cardiac interventions, most patients with tetralogy of Fallot (TOF) can survive into adulthood. Long-term follow-up, however, has revealed that these patients are at risk of ventricular arrhythmia and sudden cardiac death (1). Patients with repaired TOF commonly have complete right bundle branch block (RBBB), detected by surface electrocardiography (EKG) with prolonged QRS duration (2). This complication is related to the patch repair of the ventricular septal defect and the right ventricular outflow tract (RVOT) incision to relieve RVOT obstruction. Risk factors for ventricular arrhythmia disclosed in previous studies include hemodynamic factors such as severe pulmonary regurgitation (PR) and increased left ventricle end-diastolic pressure and electrophysiologic factors such as prolonged QRS duration (3,4). The possible mechanism includes a mechanoelectrical interaction that PR could increase right ventricular loading, which further aggravates QRS prolongation (5). Thus, the depolarization and repolarization inhomogeneity and secondary QT prolongation contribute to the development of ventricular arrhythmia. However, the interaction is complex and difficult to elucidate (6).Recently, several animal models have been proposed to simulate the hemodynamic changes in repaired TOF patients by using pulmonary valvotomy or transannular patch (7-11). Although effective in hemodynamic simulation, the importance of electrophysiological factor was seldom addressed. Thus, these models may not adequately represent the whole clinical scenario of repaired TOF. We therefore created a novel animal model in which RVOT transannular patch, PR creation, and RBBB by radiofrequency ablation would all be present to ...

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Chiu

Huang

Chang³

et al. 2011

Pediatr Res

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“…Another well-investigated index of transmural dispersion of repolarization is TpTe, which was shown to be helpful for predicting the risk for lifethreatening ventricular arrhythmias (21). Furthermore, previous studies reported that prolonged TpTe was associated with ventricular arrhythmia and sudden cardiac death in patients with hypertrophic cardiomyopathy (22), end-stage renal failure (23), inducible ventricular tachycardia (24), recent MI (25), long-QT syndrome (26), operated tetralogy of Fallot (27), and Brugada syndrome (28). TpTe/QT and TpTe/QTC, relatively novel markers for repolarization abnormalities, are not affected by heart rate and body mass in contrast to TpTe (29).…”

Section: Discussionmentioning

confidence: 99%

Assessment of repolarization abnormalities in baseline electrocardiograms of patients with myocarditis

Güneş¹,

Güler²,

Güler³

et al. 2017

Turk J Med Sci

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Background/aim: Myocarditis in the acute phase usually presents with sinus tachycardia but many other arrhythmias might be seen as well. In this study we aimed to investigate repolarization abnormalities in baseline ECG of patients with myocarditis for the first time.Materials and methods: Thirty patients diagnosed with myocarditis and 25 healthy age-matched controls were included. Two different cardiologists measured corrected QT (QTc), QT dispersion (QTd), QT peak (QTp), T wave peak to T wave end (TpTe), TpTe/QT ratio, and TpTe/QTc ratio in 12-lead ECG.Results: When compared with the control group, QTp (P: 0.021), QT (P: 0.003), TpTe (P < 0.001), TpTe/QTc ratio (P < 0.001), and TpTe/ QT ratio (P: 0.005) were significantly higher in patients with myocarditis. A comparison of receiver operating characteristic (ROC) curves was conducted using the Hanley and McNeil method. The area under the curve (AUC) of the electrocardiographic characteristics QT (AUC: 0.736; 95% CI [0.600-0.846]), QTP (AUC: 0.680; 95% CI [0.540-0.799]), and TpTe (AUC: 0.771; 95% CI [0.638-873]) and TpTe/QTc (AUC: 0.774; 95% CI [0.641-0.876]) and TpTe/QT (AUC: 0.726; 95% CI [0.589-0.838]) in myocarditis were not significantly different from each other but all of them were different from 0.5. Conclusion:Baseline ECGs of patients with myocarditis were associated with repolarization abnormalities. These novel findings may be one of the reasons underlying arrhythmic events in patients with myocarditis.

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“…Tp-e/ QT and Tp-e/QTc are relatively new markers which also indicate repolarization defects. Published studies clearly suggest the applicability of Tp-e/QT ratio as a potentially important index of arrhythmogenesis, both under the conditions of short, normal and long QT interval, as well as in congenital and acquired channelopathies, in various high-risk populations, such as, patients with long QT syndrome [19], hypertrophic cardiomyopathy [20], post-myocardial infarction [21], inducible ventricular tachycardia [24,25], repaired tetralogy of Fallot [26] or Brugada syndrome [27], Tp-e interval had been found to be more prolonged than control patients. Underlying mechanism of Tp-e prolongation and ventricular repolarization abnormality was proposed by Antzelevitch and coworkers [18].…”

Section: Discussionmentioning

confidence: 99%

Tp-e Interval and Tp-e/QT Ratio in Chronic Renal Failure Patients Requiring Hemodialysis

2016

Ann Clin Anal Med

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ÖzetAmaç: Kronik renal yetersizlik (KRY) ventriküler aritmi için ana etkenlerden birisidir. Kronik infilamasyon ve diğer faktörler aritmojenik yüzeyin oluşumuna katkıda bulunurlar. Çalışmamızın amacı hemodiyaliz uygulanan KRY hastalarında QT dispersiyonu, hastalarında T dalga zirve ile sonlanım noktası arası mesafe (Tp-e aralığı), Tp-e/QT oranı ve Tp-e/QTc oranını kullanarak ventrikü-ler repolarizasyonu değerlendirmekti. Gereç ve Yöntem: KRY nedeniyle hemodiyaliz tedavisi almakta olan 35 hastanın elektrokardiyogramları incelendi. T dalga zirve ile sonlanım noktası arası mesafe, QT süresi, düzeltilmiş QT sü-resi ve EKG aralıkları ölçüldü. Yaş ve cinsiyet uyumlu 30 sağlıklı kişinin elektrokardiyogramları ile karşılaştırıldı. Bulgular: KRY grubu ile kontrol grubu birbirlerinden hesaplanmış Tp-e (92.9±24.7 ya karşı 77.0±9.6, p=0.002), Tp-e/ QTc (0.20±0.0 a karşı 0.18±0.0, p=0.007) , QTd (58.9±45.6 ya karşı 27.3±7.6, p=0.001) ve Tp-e/QT (0.24±0.1 e karşı 0.21±0.0, p=0.034) açısından anlamlı derecede farklıydı. QTc (457.9±50.8 e karşı 436.4±43.1, p=0.077) ise her iki grupta da benzerdi. Tartışma: QTd, Tp-e, Tp-e/QT ve Tp-e/QTc repolarizasyonu kusurlarını gösteren oldukça yeni göstergelerdir. Bizim bulgularımız bu göstergelerin KRY nedeniyle hemodiyalize giren hastalarda ventriküler elektriksel kararsızlığın belirlenmesinde kullanılabileceğini göstermektedir. Anahtar KelimelerTp-e; Kronik Renal Yetersizlik; Hemodiyaliz; Aritmi Abstract Aim: Chronic renal failure (CRF) is a major factor for ventricular arrhythmia. Chronic inflammation and other factors contribute to formation of arrhythmogenic substrate. The aim of our study was to assess ventricular repolarization in CRF patients receiving hemodialysis, by using QT dispersion, T wave peak to T wave end interval (Tp-e interval), Tp-e/QT ratio, and Tp-e/QTc ratio. Material and Method: Electrocardiogram of 35 CRF patients receiving hemodialysis were studied. T wave peak to end interval, QT and corrected QT intervals and some other ECG intervals were measured. Electrocardiograms of age and sex matched 30 healthy individuals were also analyzed for comparison. Results: CRF group and control group were significantly different from each other for calculated p=0.002), Tp-e/ QTc (0.20±0.0 vs 0.18±0.0, p=0.007) , QTd (58.9±45.6 vs 27.3±7.6, p=0.001), and Tp-e/QT (0.24±0.1 vs 0.21±0.0, p=0.034)values. QTc (457.9±50.8 e karşı 436.4±43.1, p=0.077) values were similar in both groups. Discussion: QTd, Tp-e, Tp-e/QT and Tp-e/QTc are relatively new markers which also indicate repolarization defects. Our findings indicate that these new markers may be useful in determination of ventricular electrical instability in CRF patients receiving hemodialysis.

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Arrhythmogenic substrate in young patients with repaired tetralogy of Fallot: Role of an abnormal ventricular repolarization

Cited by 28 publications

References 58 publications

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Assessment of repolarization abnormalities in baseline electrocardiograms of patients with myocarditis

Tp-e Interval and Tp-e/QT Ratio in Chronic Renal Failure Patients Requiring Hemodialysis

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