Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume

Huysduynen, Bart Hooft van; Straten, Alexander van; Swenne, Cees A.; Maan, Arie C.; Eck, Henk J. Ritsema van; Schalij, Martin J.; Wall, Ernst E. van der; Roos, Albert de; Hazekamp, Mark G.; Vliegen, Hubert W.

doi:10.1093/eurheartj/ehi140

Cited by 83 publications

(54 citation statements)

References 19 publications

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“…394 PVR has been shown to improve pulmonary regurgitation and to be protective against the development of recurrent ventricular and atrial arrhythmias. 134,[396][397][398] The salutary effects of PVR before clinical manifestations may be related to a reduction of the QRS duration 399 or stabilization of the QRS duration. 134 Correlations between smaller RV size and reduced arrhythmia vulnerability suggest that a measurable reduction in RV size may be an important precursor required for favorable QRS changes after PVR.…”

Section: Pulmonary Valve Regurgitationmentioning

confidence: 99%

Congenital Heart Disease in the Older Adult

Bhatt¹,

Foster²,

Kuehl³

et al. 2015

Circulation

203

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Section: Pulmonary Valve Regurgitationmentioning

confidence: 99%

Congenital Heart Disease in the Older Adult

Bhatt¹,

Foster²,

Kuehl³

et al. 2015

Circulation

203

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“…[31][32][33] Furthermore, pulmonary valve replacement in patients with repaired ToF and pulmonary regurgitation causes a reduction in QRSd that most likely is a result of the fact that slowconducting and partly fibrotic tissue is resected at the same time. 34,35 A decrease in the incidence of ventricular tachycardia has been noted when pulmonary valve replacement is combined with electrophysiological mapping and cryoablation. 35 We would speculate, therefore, that routine electrical "isolation" of the RVOT at the time of pulmonary valve replacement might reduce the risk of ventricular tachycardia and sudden death in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Mechanics and QRS Duration in Patients With Repaired Tetralogy of Fallot

et al. 2007

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Background-Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be candidates for cardiac resynchronization therapy. We aimed to assess the relationship between QRSd and the timing of RV wall motion, including the RV outflow tract (RVOT), in these patients. Methods and Results-Sixty-seven repaired ToF patients (median age, 34 years; interquartile range, 24 to 43 years) and 35 age-matched control subjects were studied by echocardiography and cardiovascular magnetic resonance (nϭ55 of 67 ToF patients). Time intervals of the RV cardiac cycle were measured from Doppler recordings. Long-axis M-mode recordings were acquired from the right ventricular (RV) free wall and RV outflow tract (RVOT), and the delay in onset of long-axis shortening was measured. ToF patients showed minor abnormalities of the RV cardiac cycle unrelated to QRSd. RV ejection time was prolonged and correspondingly filling time was reduced compared with control subjects (22.3Ϯ2.6 versus 20.0Ϯ2.9 s/min, PϽ0.0001; 29.0Ϯ3.8 versus 32.7Ϯ3.5 s/min, PϽ0.0001). Total isovolumic time was normal in ToF patients (8.7Ϯ4.0 versus 7.4Ϯ2.9 s/min; PϭNS). QRSd correlated with the delay in RV free wall motion (rϭ0.55, PϽ0.0001) and more so with the delay in RVOT shortening (rϭ0.82, PϽ0.0001). QRSd also correlated with measures of RVOT abnormality such as long-axis RVOT excursion and akinetic area length (rϭϪ0. 46, Pϭ0.004; rϭ0.33, Pϭ0.01). Conclusions-QRSd in postoperative ToF patients reflects mainly abnormalities of the RVOT rather than the RV body itself. Thus, prevention and treatment of mechanical asynchrony and malignant arrhythmia should focus on the RV infundibulum. Indications for cardiac resynchronization therapy after ToF repair warrant further investigation.

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“…Risk for these ventricular arrhythmias is higher when QRS duration is Ͼ180 ms. 14 It has been observed that QRS duration decreases after PVR, related to the reduction in RV volumes. 15 Ventricular arrhythmias or sudden cardiac death occurred in 3 of 71 (4%) of the patients. In a recent study, we observed that when patients were operated on when QRS was Ͼ180 ms, the risk for ventricular arrhythmias remained high (25%).…”

Section: Other Factors Influencing Optimal Timing Of Pvrmentioning

confidence: 98%

Preoperative Thresholds for Pulmonary Valve Replacement in Patients With Corrected Tetralogy of Fallot Using Cardiovascular Magnetic Resonance

et al. 2007

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Background-To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery. Methods and Results-Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42Ϯ10% to 43Ϯ10%; Pϭ0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m 2 ) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: ␤ϭ0.41; PϽ0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m 2 for normalization of RV end-diastolic volume or 82 mL/m 2 for RV end-systolic volume. Conclusions-Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was Ͻ160 mL/m 2 or RV end-systolic volume was Ͻ82 mL/m 2 . (Circulation. 2007;116:545-551.)

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Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume

Abstract: Our study shows that PVR reduces QRS duration. The amount of QRS reduction is related to the success of the operation, as expressed by the reduction in RV end-diastolic volume.

Cited by 83 publications

References 19 publications

Congenital Heart Disease in the Older Adult

Congenital Heart Disease in the Older Adult

Right Ventricular Mechanics and QRS Duration in Patients With Repaired Tetralogy of Fallot

Preoperative Thresholds for Pulmonary Valve Replacement in Patients With Corrected Tetralogy of Fallot Using Cardiovascular Magnetic Resonance

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