Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement

Abstract

Background: Patients with tetralogy of Fallot (TOF) have increased risk of atrial arrhythmias.

P‐wave vector magnitude predicts recurrence of atrial fibrillation after catheter ablation in patients with persistent atrial fibrillation

“…However, right atrial electrical activation may be associated with P‐wave vector magnitude to some extent because we did not observe a difference in P‐wave vector magnitude between patients who underwent left atrial posterior wall isolation with mitral isthmus line ablation and patients receiving CFAE ablation. This conclusion is further supported by a previous study (Cortez, Barham et al, ; Cortez, Baturova et al, ) reporting that P‐wave vector magnitude inversely correlated with right atrial pressure and right ventricular ejection fraction.…”

“…Fourth, since antiarrhythmic drugs were resumed at the discretion of the treating physician, we cannot exclude the influence of antiarrhythmic drugs on outcome; however, the influence of antiarrhythmic drugs may have been weak because administration rates were similar between recurrence and AF‐free groups. Fifth, P‐wave vector magnitude was calculated from the PWA measured from leads II, V2, and V6 based on Kors' quasi‐orthogonal transformation (Cortez, Barham et al, ; Cortez, Baturova et al, ; Kors et al, ); however, this method may not reproduce the orthogonal electrocardiogram accurately. Finally, AF recurrence was diagnosed by a clinical interview and clinical examinations, including surface ECG and 24‐hr Holter monitoring, a method that is well known for underestimating the prevalence of AF because it neglects asymptomatic AF.…”

“…P‐wave vector magnitude was calculated from the PWA measured from orthogonal electrocardiographic leads II, V2, and V6. The root‐mean‐square formula is based on Kors' quasi‐orthogonal transformation (Cortez, Barham et al, ; Cortez, Baturova et al, ; Kors, van Herpen, Sittig, & van Bemmel, ): …”

“…Furthermore, PWA may not accurately reflect the magnitude of atrial electrical activation because direction of propagation influences the PWA measured at each electrocardiographic lead. On the other hand, P‐wave vector magnitude (Cortez, Barham et al, ; Cortez, Baturova et al, ) , which indicates the P‐wave magnitude in three‐dimensional space according to vectorcardiographic principles, may be a more accurate reflection of atrial electrical activation because it is not affected by direction. Thus, the present study aimed to assess the predictive efficacies of PWA parameters including P‐wave vector magnitude for AF recurrence after catheter ablation of persistent AF.…”

Postoperative and short‐term atrial tachyarrhythmia burdens after transcatheter vs surgical pulmonary valve replacement among congenital heart disease patients

“…After censoring events in the first 30 days, the combined freedom from atrial tachyarrhythmias (after TC‐PVR or S‐PVR) at 5 years was still 78%. Similar to previously published data on a surgical cohort, 22% of patients still had an AT event by 5 years after PVR, suggesting that there may be other factors implicated in the development of atrial arrhythmias in this population. Nevertheless, given the associated early benefits from a transcatheter approach, including shorter hospital stay, faster recovery, decreased morbidity/adverse events, reduced 30‐day readmission rates, and overall decrease in the arrhythmia burden in the first 30 days after valve implantation, TC‐PVR should be considered preferentially before S‐PVR among eligible CHD patients, ideally at centers experienced to perform such interventions.…”