Changes during exercise of ECG intervals related to increased risk for ventricular arrhythmia in repaired tetralogy of Fallot and their relationship to right ventricular size and function

Berg, Jochem van den; Bie, Sandra de; Meijboom, Folkert J.; Hop, Wim C. J.; Pattynama, Peter M. T.; Bogers, Ad J.J.C.; Helbing, Willem A.

doi:10.1016/j.ijcard.2007.02.009

Cited by 12 publications

(3 citation statements)

References 34 publications

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“…Such underlying histopathological findings have been previously proposed to explain depolarisation abnormalities occurring late after KD [30]. To our knowledge, this is the first study on exercise QTc dispersion in KD and one of just a few in children [37]. Based on our exercise protocol, healthy subjects increased QTc dispersion at peak exercise similar to healthy adults [1,32] whereas KD subjects had an attenuated response.…”

Section: Discussionsupporting

confidence: 62%

Ventricular Repolarisation During Exercise Challenge Occurring Late After Kawasaki Disease

et al. 2012

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Exercise testing can highlight repolarisation abnormalities in adults with coronary artery disease. Late after Kawasaki disease (KD), increased QT dispersion (QTd) has been reported on resting ECG in children, but there are no reported studies of QTd during exercise. Our objective was to determine the pattern of QTd response to exercise testing in children late after KD. Twenty-five KD patients without coronary complications, 28 with coronary dilation, and 18 with severe complications were compared with 28 controls. KD patients were 11.6 ± 3.0 years old versus 12.8 ± 2.9 for controls [p = not significant (NS)], and these patients were studied 7.5 ± 3.4 years after the onset of the disease. QT was measured from the onset of QRS to the apex (QTa) and the end (QTe) of T wave. Resting QTd was significantly increased in KD subjects (p < 0.05). The proportion of abnormal QTd was evenly distributed across the three KD groups (29-36%; p = NS). QTd response to exercise was significantly altered in KD, irrespective of resting QTd or coronary sequelae. Abnormal resting- and exercise-induced repolarisation are detectible after KD irrespective of the severity of coronary sequelae.

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Section: Discussionsupporting

confidence: 62%

Ventricular Repolarisation During Exercise Challenge Occurring Late After Kawasaki Disease

et al. 2012

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“…In conclusion, during physical exercise inhomogeneity of repolarisation, known to predispose to reentry ventricular arrhythmia, increased in repaired TOF. A greater inhomogeneity was found in the presence of more severe pulmonary regurgitation [36]. A temporal and regional variation in ventricular repolarization across the myocardium in patients with repaired TOF could represent a pathophysiological substrate for an increased cardiac electrical instability.…”

Section: Qrs Duration and Physical Exercisementioning

confidence: 99%

QRS Complex Enlargement as a Predictor of Ventricular Arrhythmias in Patients Affected by Surgically Treated Tetralogy of Fallot: A Comprehensive Literature Review and Historical Overview

Bassareo

Mercuro

2013

ISRN Cardiology

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Tetralogy of Fallot (TOF) is a congenital heart disease frequently treated by surgical repair to relieve symptoms and improve survival. However, despite the performing of an optimal surgical repair, TOF patients are at times characterized by a poor long-term survival rate, likely due to cardiac causes such as ventricular arrhythmias, with subsequent sudden death. In the 80s it was irrefutably demonstrated that QRS prolongation ≥180 msec at basal electrocardiogram is a strong predictor for refining risk stratification for ventricular tachycardia in these patients. The aim of this research was to undertake a review of all studies conducted to assess the impact of QRS duration on the development of life-threatening ventricular arrhythmias in repaired TOF subjects.

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“…Berul et al found that a QTc was longer in patients with rTOF who developed VT but inferior as a marker than QRS duration ( 10 ). Van den Berg et al described that QTc was prolonged in patients with rTOF but did not change with exercise ( 38 ). Furthermore, it was associated with worsening RVEF and larger RV volume.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal ECG changes in tetralogy of Fallot and association with surgical repair

Bhat,

Malm,

Sjöberg

et al. 2024

Front. Cardiovasc. Med.

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BackgroundECG abnormalities have been linked to adverse changes in right ventricular (RV) morphology and poor clinical outcomes in repaired Tetralogy of Fallot (rTOF). Our aim was to describe how ECG changes progress in early and intermediate follow-up and whether types of surgical strategy at the time of primary repair affected these changes.MethodsWe studied patients with rTOF born 2000–2018 operated at our institution. Seven time points in relation to primary repair, follow-up, and pulmonary valve replacement (PVR) were identified. Patients correct with valve sparing repair (VSR), trans-annular patch (TAP) including with a monocusp valve (TAP + M) and with at least 3 ECGs were included. PQ interval, QRS duration, dispersion, and fragmentation, QTc duration and dispersion, JTc as well as presence of a right bundle branch block (RBBB) were analyzed. Medical records were reviewed for demographic and surgical data.ResultsTwo hundred nineteen patients with 882 ECGs were analyzed with a median follow-up time of 12.3 years (8.4, 17) with 41 (19%) needing PVR during the study period. QRS duration increased at time of primary repair to discharge from 66 msec (IQR 12) to 129 msec (IQR 27) (p < 0.0001) and at 1- and 6- year follow-up but showed only a modest and temporary decrease after PVR. QTc increased at the time of primary repair as well as prior to PVR. PQ interval showed a small increase at the time of primary repair, was at its highest prior to PVR and decreased with PVR. Type of surgical repair affected mainly QTc and JTc and was consistently longer in the TAP + M group until PVR. In VSR, QTc and JTc were prolonged initially compared to TAP but were similar after 1 year. After PVR, there were no differences in adverse ECG changes between surgical groups.ConclusionsPQ interval and QRS duration best correspond to the assumed volume load whereas the relationship with QTc and JTc is more complex, suggesting that these represent more complex remodeling of the myocardium. Before PVR, QTc and JTc are longer in the TAP + M group which may be due to a longer surgical incision.

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Changes during exercise of ECG intervals related to increased risk for ventricular arrhythmia in repaired tetralogy of Fallot and their relationship to right ventricular size and function

Cited by 12 publications

References 34 publications

Ventricular Repolarisation During Exercise Challenge Occurring Late After Kawasaki Disease

Ventricular Repolarisation During Exercise Challenge Occurring Late After Kawasaki Disease

QRS Complex Enlargement as a Predictor of Ventricular Arrhythmias in Patients Affected by Surgically Treated Tetralogy of Fallot: A Comprehensive Literature Review and Historical Overview

Longitudinal ECG changes in tetralogy of Fallot and association with surgical repair

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