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QRS Duration After Pulmonary Valve Replacement in Adults with Repaired Tetralogy of Fallot: Association with Ventricular Arrhythmia and Correlation with Right Ventricular Size

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Abstract

The aim of this study is to analyze the relationship between QRS duration after pulmonary valve replacement (PVR) and ventricular arrhythmias (VA) in patients with repaired tetralogy of Fallot (ToF). ToF patients may face complications such as heart failure and VA after primary repair, often mitigated by PVR. Prior studies have shown a decrease in QRS duration and right ventricular (RV) size following PVR. It remains unclear whether a lack of QRS duration reduction identifies patients at risk of VA. We retrospectively identified adult patients with repaired ToF who underwent surgical or transcatheter PVR. EKG data (pre-PVR, 30 days to 1-year post-PVR, and closest to CMR) was collected. The primary endpoint was sustained ventricular tachycardia (VT), ICD shock for sustained VT, or inducible VT on EP study. 85 patients were included (median follow-up 3.6 years; median age 34 years; 51% females). The primary outcome was noted in 8 patients. Mean QRS duration decreased by 5 ms following PVR (p = 0.0001). Increased age at PVR, QRS ≥ 180 ms post-PVR, no reduction in QRS after PVR, and a history of VT were associated with higher risk of the primary endpoint. The change in QRS was linearly correlated with the change in RVEDVi (R = 0.66). Adults with repaired ToF experience a reduction in QRS duration post-PVR that correlates with the change of the RV size. Patients with QRS ≥ 180 ms post-PVR, no reduction in QRS, increased age at repair, and a history of VT are at risk for recurrent VT and warrant closer monitoring/ICD consideration.

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The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.

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Author notes

  1. Rody G. Bou Chaaya and Emily Barron have contributed equally.

Authors and Affiliations

  1. Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Rody G. Bou Chaaya

  2. Cardiovascular Institute, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN, USA

    Emily Barron

  3. Section of Pediatric Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Jeremy L. Herrmann & John W. Brown

  4. Riley Children’s Health, Indiana University Health, Indianapolis, IN, USA

    Jeremy L. Herrmann & John W. Brown

  5. University of Tennessee Health Science Center, Memphis, TN, USA

    Georges Ephrem

Authors
  1. Rody G. Bou Chaaya
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  2. Emily Barron
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  3. Jeremy L. Herrmann
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  4. John W. Brown
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  5. Georges Ephrem
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Contributions

RGBC took the lead in writing the manuscript. All authors designed the study, collected, analyzed, and interpreted the data, cared for the patients, provided critical feedback, and helped shape and edit the final manuscript.

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Correspondence to Rody G. Bou Chaaya.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Ethical review and IRB approval was obtained for the study in accordance with the local legislation and institutional requirements.

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Bou Chaaya, R.G., Barron, E., Herrmann, J.L. et al. QRS Duration After Pulmonary Valve Replacement in Adults with Repaired Tetralogy of Fallot: Association with Ventricular Arrhythmia and Correlation with Right Ventricular Size. Pediatr Cardiol 44, 1658–1666 (2023). https://doi.org/10.1007/s00246-023-03272-0

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  • DOI: https://doi.org/10.1007/s00246-023-03272-0

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