(Circulation. 1997;95:401-404.)
© 1997 American Heart Association, Inc.
Articles |
Depolarization-Repolarization Inhomogeneity After Repair of Tetralogy of Fallot
The Substrate for Malignant Ventricular Tachycardia?
the Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.
Correspondence to Prof Andrew N. Redington, Royal Brompton Hospital/National Heart and Lung Institute, Sydney St, London SW3 6NP, UK.
Background We have previously shown that QRS prolongation (
180 ms) is a risk marker for sustained ventricular tachycardia (VT) late after repair of tetralogy of Fallot (rTOF). We have now examined the dispersion of QT and its components QRS and JT, in an attempt to determine whether any association exists between these measurements and the presence of VT in these patients.
Methods and Results QRS duration and QT/QRS/JT dispersion were measured manually from standard ECGs in 10 syncopal rTOF patients (21.4±4.6 years after repair; group 1) with QRS180 ms and with documented VT and were compared with 9 rTOF patients with QRS 180 ms and no VT (group 2), 40 rTOF patients with QRS <180 ms and no clinical arrhythmias (group 3), and 40 nontetralogy control subjects (20 with right bundle-branch block [group 4] and 20 with normal ECG patterns [group 5]). Mean QT dispersion (62±36 ms) in the tetralogy patients was greater than in the nontetralogy control subjects (34±10 ms, P<.001). There were significant differences in all measured parameters between groups 1 and 3 and more importantly between groups 1 and 2. QRS dispersion in group 1 also correlated with QRS duration but not with JT dispersion.
Conclusions Our data suggest that both depolarization and repolarization abnormalities are associated with VT after rTOF. Furthermore, increased QT, QRS, and JT dispersions, combined with a QRS180 ms, refine risk stratification for VT in these patients.
Key Words: tetralogy of Fallot • arrhythmia • syncope • electrocardiography
This article has been cited by other articles:
 |
|
 |
|
  A. Frigiola, V. Tsang, J. Nordmeyer, P. Lurz, C. van Doorn, A. M. Taylor, P. Bonhoeffer, and M. de Leval Current approaches to pulmonary regurgitation Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 576 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Gengsakul, L. Harris, T. J. Bradley, G. D. Webb, W. G. Williams, S. C. Siu, N. Merchant, and B. W. McCrindle The impact of pulmonary valve replacement after tetralogy of Fallot repair: a matched comparison Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 462 - 468. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. Berdat and T. P. Carrel Reply to the Editor J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 990 - 991. [Full Text] [PDF]
|
|
|
|
 |
|
 P A Davlouros, K Niwa, G Webb, and M A Gatzoulis The right ventricle in congenital heart disease Heart, April 1, 2006; 92(suppl_1): i27 - i38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. V. Babu-Narayan, P. J. Kilner, W. Li, J. C. Moon, O. Goktekin, P. A. Davlouros, M. Khan, S. Y. Ho, D. J. Pennell, and M. A. Gatzoulis Ventricular Fibrosis Suggested by Cardiovascular Magnetic Resonance in Adults With Repaired Tetralogy of Fallot and Its Relationship to Adverse Markers of Clinical Outcome Circulation, January 24, 2006; 113(3): 405 - 413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Khambadkone, L. Coats, A. Taylor, Y. Boudjemline, G. Derrick, V. Tsang, J. Cooper, V. Muthurangu, S. R. Hegde, R. S. Razavi, et al. Percutaneous Pulmonary Valve Implantation in Humans: Results in 59 Consecutive Patients Circulation, August 23, 2005; 112(8): 1189 - 1197. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. H. van Huysduynen, A. van Straten, C. A. Swenne, A. C. Maan, H. J. Ritsema van Eck, M. J. Schalij, E. E. van der Wall, A. de Roos, M. G. Hazekamp, and H. W. Vliegen Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume Eur. Heart J., May 1, 2005; 26(9): 928 - 932. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. V. Babu-Narayan, O. Goktekin, J. C. Moon, C. S. Broberg, G. A. Pantely, D. J. Pennell, M. A. Gatzoulis, and P. J. Kilner Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Systemic Right Ventricle in Adults With Previous Atrial Redirection Surgery for Transposition of the Great Arteries Circulation, April 26, 2005; 111(16): 2091 - 2098. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A.E. Kammeraad, C. H.M. van Deurzen, N. Sreeram, M. Th.E. Bink-Boelkens, J. Ottenkamp, W. A. Helbing, J. Lam, M. A. Sobotka-Plojhar, O. Daniels, and S. Balaji Predictors of sudden cardiac death after mustard or senning repair for transposition of the great arteries J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1095 - 1102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R.P. Steeds and D. Oakley Predicting late sudden death from ventricular arrhythmia in adults following surgical repair of tetralogy of Fallot QJM, January 1, 2004; 97(1): 7 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W A Helbing, A A W Roest, R A Niezen, H W Vliegen, M G Hazekamp, J Ottenkamp, A de Roos, and E E van der Wall ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation Heart, December 1, 2002; 88(5): 515 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J G J Neffke, I I Tulevski, E E van der Wall, A A M Wilde, D J van Veldhuisen, A Dodge-Khatami, and B J M Mulder ECG determinants in adult patients with chronic right ventricular pressure overload caused by congenital heart disease: relation with plasma neurohormones and MRI parameters Heart, September 1, 2002; 88(3): 266 - 270. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K Triedman Arrhythmias in adults with congenital heart disease Heart, April 1, 2002; 87(4): 383 - 389. [Full Text] [PDF]
|
|
|
|
|
|
T. D. Gbadebo, R. W. Trimble, M. S.C. Khoo, J. Temple, D. M. Roden, and M. E. Anderson Calmodulin Inhibitor W-7 Unmasks a Novel Electrocardiographic Parameter That Predicts Initiation of Torsade de Pointes Circulation, February 12, 2002; 105(6): 770 - 774. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Turrini, D. Corrado, C. Basso, A. Nava, B. Bauce, and G. Thiene Dispersion of Ventricular Depolarization-Repolarization : A Noninvasive Marker for Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy Circulation, June 26, 2001; 103(25): 3075 - 3080. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Therrien, S. C. Siu, L. Harris, A. Dore, K. Niwa, J. Janousek, W. G. Williams, G. Webb, and M. A. Gatzoulis Impact of Pulmonary Valve Replacement on Arrhythmia Propensity Late After Repair of Tetralogy of Fallot Circulation, May 22, 2001; 103(20): 2489 - 2494. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Vogel, J. Sponring, S. Cullen, J. E. Deanfield, and A. N. Redington Regional Wall Motion and Abnormalities of Electrical Depolarization and Repolarization in Patients After Surgical Repair of Tetralogy of Fallot Circulation, March 27, 2001; 103(12): 1669 - 1673. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M A Gatzoulis, J Walters, P R McLaughlin, N Merchant, G D Webb, and P Liu Late arrhythmia in adults with the Mustard procedure for transposition of great arteries: a surrogate marker for right ventricular dysfunction? Heart, October 1, 2000; 84(4): 409 - 415. [Abstract] [Full Text]
|
|
|
|
|
|
M Y A. El Rahman, H Abdul-Khaliq, M Vogel, V Alexi-Meskishvili, M Gutberlet, and P E Lange Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair Heart, October 1, 2000; 84(4): 416 - 420. [Abstract] [Full Text]
|
|
|
|
 |
|
 P. Schaffer, B. Pelzmann, E. Bernhart, P. Lang, H. Machler, B. Rigler, and B. Koidl Repolarizing currents in ventricular myocytes from young patients with tetralogy of Fallot Cardiovasc Res, August 1, 1999; 43(2): 332 - 343. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L Daliento, G Rizzoli, L Menti, M C Baratella, P Turrini, A Nava, and S Dalla Volta Accuracy of electrocardiographic and echocardiographic indices in predicting life threatening ventricular arrhythmias in patients operated for tetralogy of Fallot Heart, June 1, 1999; 81(6): 650 - 655. [Abstract] [Full Text]
|
|
|
|
|
|
K A McLeod, W S Hillis, A B Houston, N Wilson, A Trainer, J Neilson, and W B Doig Reduced heart rate variability following repair of tetralogy of Fallot Heart, June 1, 1999; 81(6): 656 - 660. [Abstract] [Full Text]
|
|
|
|
|
|
P. Munkhammar, S. Cullen, P. Jogi, M. de Leval, M. Elliott, and G. Norgard Early age at repair prevents restrictive right ventricular (RV) physiology after surgery for tetralogy of Fallot (TOF): Diastolic RV function after TOF repair in infancy J. Am. Coll. Cardiol., October 1, 1998; 32(4): 1083 - 1087. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L Oikarinen, L Toivonen, and M Viitasalo Electrocardiographic measures of ventricular repolarisation dispersion in patients with coronary artery disease susceptible to ventricular fibrillation Heart, June 1, 1998; 79(6): 554 - 559. [Abstract] [Full Text]
|
|
|
|
|
|
G Norgård, M A Gatzoulis, M Josen, S Cullen, and A N Redington Does restrictive right ventricular physiology in the early postoperative period predict subsequent right ventricular restriction after repair of tetralogy of Fallot? Heart, May 1, 1998; 79(5): 481 - 484. [Abstract] [Full Text]
|
|