Pediatric Cardiology

, Volume 38, Issue 5, pp 1049–1056 | Cite as

Clinical Application of the QRS-T Angle for the Prediction of Ventricular Arrhythmias in Patients with the Fontan Palliation

Original Article

Abstract

Fontan palliation patients are at risk for ventricular arrhythmias post-operatively. This study aimed to evaluate whether differences in the spatial QRS-T angle can reliably predict ventricular arrhythmias in patients who had undergone Fontan palliation. A total of 117 patients who had the Fontan palliation and post-Fontan catheterization were included. Ventricular arrhythmias were identified in nine patients. Measurements of ECG parameters including QRS vector magnitude, QRS duration, corrected QT interval, and spatial peaks QRS-T angles were performed, and compared between those with and without ventricular arrhythmias. The only ECG parameter to distinguish those with versus those without VA was the SPQRS-T angle (p < 0.001), which at a cut-off value of 102.9° gave sensitivity, specificity, positive and negative predictive values of 100.0, 57.0, 17.6 and 100.0%, respectively. Only the spatial peaks QRS-T angle differentiated those with and without ventricular arrhythmia development with a univariate HR 1.237 (95% CI 1.021–1.500) and a multivariate HR of 1.032 (1.009–1.056) when catheter measured parameters were taken into account. In Fontan patients, the spatial peaks QRS-T angle is a significant independent predictor of ventricular arrhythmias. Clinical usefulness of this parameter remains to be seen and should be tested prospectively.

Keywords

Fontan Vectorcardiography Ventricular arrhythmias 

Notes

Funding

No funding was given for this study.

Compliance with Ethical Standards

Conflicts of interest

No conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies were in accordance with ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Supplementary material

246_2017_1618_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 43 kb)

References

  1. 1.
    Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26:240–248CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gale AW, Danielson GK, McGoon DC et al (1979) Modified Fontan operation for univentricular heart and complicated congenital lesions. J Thorac Cardiovasc Surg 78:8310838Google Scholar
  3. 3.
    Tweddell JS, Nersesian M, Mussatto KA et al (2009) Fontan palliation in the modern era: factors impacting mortality and morbidity. Ann Thorac Surg 88:1291–1299CrossRefPubMedGoogle Scholar
  4. 4.
    Peters NS, Sommerville J (1992) Arrhythmias after the Fontan procedure. Br Heart J 68:199–204CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Deal BJ (2012) Late arrhythmias following Fontan surgery. World J Pediatr Congenit Heart Surg 3:194–200CrossRefPubMedGoogle Scholar
  6. 6.
    Mertens L, Hagler DJ, Somerville J (1998) Protein-losing enteropathy after the Fontan operation: an international multicenter study. PLE study group. J Thorac Cardiovasc Surg 115:1063–1073CrossRefPubMedGoogle Scholar
  7. 7.
    Rydberg A, Karlsson M, Hörnsten R (2008) Can analysis of heart rate variability predict arrhythmia in children with Fontan circulation? Pediatr Cardiol 29:50–55CrossRefPubMedGoogle Scholar
  8. 8.
    Durongpisikul K, Porter CJ, Cetta F et al (1998) Predictors of early- and late-onset supraventricular tachyarrhythmias after Fontan operation. Am Heart Assoc 98:1099–1107Google Scholar
  9. 9.
    Gelatt M, Hamilton RM, McCrindle BW et al (1994) Risk factors for atrial tachyarrhythmias after the Fontan operation. J Am Coll Cardiol 24:1735–1741CrossRefPubMedGoogle Scholar
  10. 10.
    Tuzcu V, Ozkan B, Sullivan N et al (2000) P wave signal-averaged electrocardiogram as a new marker for atrial tachyarrhythmias in postoperative Fontan patients. J Am Coll Cardiol 36:602–607CrossRefPubMedGoogle Scholar
  11. 11.
    Yamada T, Fukunami M, Shimonagata T et al (2001) Identification of sinus node dysfunction by use of P-wave signal-averaged electrocardiograms in paroxysmal atrial fibrillation: a prospective study. Am Heart J 142:286–293CrossRefPubMedGoogle Scholar
  12. 12.
    Voulgari C, Pagoni S, Tesfaye S et al (2013) The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev 9:197–210CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cortez D, Graw S, Mestroni L (2016) In hypertrophic cardiomyopathy, the spatial peaks QRS-T angle identifies those with sustained ventricular arrhythmias. Clin Cardiol 39:459–463CrossRefPubMedGoogle Scholar
  14. 14.
    Rautaharju PM, Prineas RJ, Wood J et al (2007) Electrocardiographic predictors of new-onset heart failure in men and in women free of coronary heart disease (from the Atherosclerosis in Communities [ARIC] study). Am J Cardiol 100:1437–1441CrossRefPubMedGoogle Scholar
  15. 15.
    Tamazaki T, Froelicher VG, Myers J et al (2005) Spatial QRS-T angle predicts cardiac death in a clinical population. Heart Rhythm 2:73–78CrossRefGoogle Scholar
  16. 16.
    Poplock Potter SL, Holvqvist F, Platonov PG et al (2010) Detection of hypertrophic cardiomyopathy is improved when using advanced rather than strictly conventional 12-lead electrocardiogram. J Electrocardiol 43:713–718CrossRefGoogle Scholar
  17. 17.
    Cortez D, Sharma N, Cavanagh J et al (2015) The spatial QRS-T angle outperforms the Italian and seattle ECG-based criteria for detections of hypertrophic cardiomyopathy. J Electrocardiol 48:826–833CrossRefPubMedGoogle Scholar
  18. 18.
    Cortez D, Sharma N, Cavanaugh J, et al (2016) Lower spatial QRS-T angle rules out sustained ventricular arrhythmias in children with hypertrophic cardiomyopathy. Cardiol YoungGoogle Scholar
  19. 19.
    Cortez D, Ruckdeschel E, McCanta AC et al (2015) Vectorcardiographic predictors of ventricular arrhythmia inducibility in patients with tetralogy of Fallot. J Electrocardiol 48:141–144CrossRefPubMedGoogle Scholar
  20. 20.
    Cortez D, Barham W, Ruckdeschel E, et al (2016) Non-invasive predictors of ventricular arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacements. JACC ElectrophysiolGoogle Scholar
  21. 21.
    Kors JA, van Herpen G, Sittig AC et al (1990) Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: diagnostic comparison of different methods. Eur Heart J 11:1083–1092CrossRefPubMedGoogle Scholar
  22. 22.
    Cortez D, Sharma N, Devers C, Devers E, Schlegel TT (2014) Visual transform applications for estimating the spatial QRS-T angle from the conventional 12-lead ECG: Kors is still most Frank. J Electrocardiol 47:12–19CrossRefPubMedGoogle Scholar
  23. 23.
    Voulgari C, Tentolouris N, Moyssakis I et al (2006) The spatial QRS-T angle: association with diabetes and left ventricular performance. Eur J Clin Investig 36:608–613CrossRefGoogle Scholar
  24. 24.
    Rautaharju PM, Ge S, Nelson JC et al (2006) Comparison of mortality risk for electrocardiographic abnormalities in men and women with and without coronary heart disease (from the cardiovascular health study). Am J Cardiol 97:309–315CrossRefPubMedGoogle Scholar
  25. 25.
    Rautaharju PM, Kooperberg C, Larson JC et al (2006) Electrocardiographic predictors of incidence congestive heart failure and all-cause mortality is postmenopausal women: the women’s health initiative. Circulation 113:481–489CrossRefPubMedGoogle Scholar
  26. 26.
    Rautaharju PM, Kooperbert C, Larson JC et al (2006) Electrocardiographic abnormalities that predict coronary heart disease events and mortality in postmenopausal women: the Women’s Health Initiaive. Circulation 113:473–480CrossRefPubMedGoogle Scholar
  27. 27.
    Kardys I, Kors JA, Van der Meer I et al (2003) Spatial QRS-T angle predicts cardiac death in a general population. Eur Heart J 24:1357–1364CrossRefPubMedGoogle Scholar
  28. 28.
    Dilaveris P, Gialafos E, Pantazis A et al (2001) The spatial QRS-T angle as a marker of ventricular repolarisation in hypertension. J Hum Hypertens 15:63–70CrossRefPubMedGoogle Scholar
  29. 29.
    Ghelani SJ, Keenan EM, Mah D et al (2016) Prolonged QRS mechanical dyssynchrony and ventricular dilation are associated with ventricular arrhythmias late after the Fontan. J Am Coll Cardio 67:936CrossRefGoogle Scholar
  30. 30.
    Peters S, Trummel M (2003) Diagnosis of arrhythmogenic right ventricular dysplasia-cardiomyopathy: value of standard ECG revisited. Ann Noninvasive Electrocardiol 8:238–245CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.University of Colorado School of MedicineAuroraUSA
  2. 2.Electrophysiology fellowPenn State Milton S. Hershey Medical CenterHersheyUSA
  3. 3.Clinical SciencesLund UniversityLundSweden

Personalised recommendations