Left Ventricular Longitudinal Function Predicts Life-Threatening Ventricular Arrhythmia and Death in Adults With Repaired Tetralogy of Fallot

Abstract

Background-Suddenwere related to the combined end point. On bivariable analysis, mitral annular plane systolic excursion and LV global longitudinal 2-dimensional strain were related to outcome independently of QRS duration (Pϭ0.002 and Pϭ0.01, respectively). In addition, a combination of echocardiographic variables, including right atrial area, right ventricular fractional area change, and LV global longitudinal 2-dimensional strain or mitral annular plane systolic excursion, was also found to be significantly related to outcome (PϽ0.001; c statistic, 0.70). Conclusions-LV longitudinal dysfunction was associated with greater risk of sudden cardiac death/life-threatening ventricular arrhythmias. In combination with echocardiographic right heart variables, also available from routine echocardiography, these measures provide important outcome information and should be considered a useful adjunct to established markers such as QRS duration in the estimation of prognosis in this challenging population. (Circulation. 2012;125:2440-2446.)

Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure gradient

“…Furthermore, several ECG parameters, including QRS duration, change rate of QRS duration, QT/JT duration and dispersion, heart rate variability, and fragmented QRS, have been recognized as risk factors for life threatening ventricular arrhythmias and SCD (1,4,6,7,12,13). Residual cardiac lesions or hemodynamic abnormalities are associated with late SCD, including elevated RV pressure due to RVOT obstruction or pulmonary artery stenosis, right ventricular volume load, right ventricular dysfunction, left ventricular longitudinal dysfunction, and left ventricular diastolic dysfunction (5,14). Despite these studies, no single risk factor has yet been identified to predict VT and SCD in patients who have undergone TOF repair.…”

“…The majority of post-repaired patients survive and reach adulthood, although some patients are at risk of several life-threatening complications, such as arrhythmia and sudden cardiac death (SCD) (1,2). Numerous reports have identified risk factors for ventricular tachyarrhythmia, including QRS duration, change rate of QRS duration, QTc duration, delay in corrective surgery, number of previous cardiac surgery, presence of ventriculotomy, trans-annular patch (TAP) repair, and left ventricular diastolic dysfunction (3)(4)(5)(6)(7). Those …”

Almanac 2012: Congenital heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology

“…In a study of repaired adult tetralogy, left ventricular longitudinal dysfunction was associated with greater risk of sudden cardiac death or life-threatening arrhythmias. 44 The authors conclude that, in combination with echocardiographic right heart variables, these measures provided important outcome information for estimating prognosis.…”

The Use of Implantable Cardioverter-defibrillators in the Prevention of Sudden Cardiac Death: A Focus on Congenital Heart Disease and Inherited Arrhythmia Syndromes

“…• Transannular patch 18 • Severe pulmonary regurgitation 18 • Right ventricular hypertrophy 20 • Right ventricular dilation 22 • Right ventricular systolic dysfunction 20 • Left ventricular systolic dysfunction 82 • QRS duration ≥ 180 ms 18,22 Transposition of the Great Arteries…”