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

Uebing, Anselm; Gibson, D G; Babu‐Narayan, Sonya V.; Diller, Gerhard Paul; Dimopoulos, Konstantinos; Göktekín, Ömer; Spence, Mark S.; Andersen, Kai; Henein, Michael Y.; Li, Wei

doi:10.1161/circulationaha.107.688770

Cited by 122 publications

(73 citation statements)

References 37 publications

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“…the hemodynamic factors may aggravate QRS (depolarization) prolongation and JT (repolarization) inhomogenicity] might result in ventricular arrhythmia. Although this hypothesis has been examined in several human studies (6), it has never been proven. Zeltser et al (10) have proposed a piglet model in which PR was created by pulmonary valvotomy and pulmonary artery banding.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Chiu

Huang

Chang³

et al. 2011

Pediatr Res

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Pulmonary regurgitation and prolonged QRS duration of right bundle branch (RBB) block are common in repaired tetralogy of Fallot (TOF) and increase the risk of sudden death. We sought to establish an animal model to reflect both abnormalities. Twenty-one canines: group I (n ϭ 7) received a surgical right ventricular outflow tract (RVOT) transannular patch plus pulmonary valve destruction; group II (n ϭ 5) received RBB ablation and sham operation; and group III (n ϭ 9) received combined interventions. Serial electrophysiological data were obtained up to 1 y. Procedure mortality was 27.6%. At 1 y, although severe pulmonary regurgitation was documented in most dogs in groups I (71%) and III (100%), progressive RVOT dilatation was noted in group III. RBB block was present in all dogs in groups II and III. However, the increments of QRS duration, QTc, JTc, and QT dispersion progression between 1 mo and 1 y were all greatest in group III. Ventricular arrhythmia events were frequent in group III (median 3.3/mo) but uncommon in groups I and II (median 1/mo). We have created a novel animal model that adequately reflects both the hemodynamic and electrophysiological characteristics of repaired TOF patients and can be applied to examine the risk of ventricular arrhythmias. (Pediatr Res 70: 247-252, 2011) W ith the advances in cardiac interventions, most patients with tetralogy of Fallot (TOF) can survive into adulthood. Long-term follow-up, however, has revealed that these patients are at risk of ventricular arrhythmia and sudden cardiac death (1). Patients with repaired TOF commonly have complete right bundle branch block (RBBB), detected by surface electrocardiography (EKG) with prolonged QRS duration (2). This complication is related to the patch repair of the ventricular septal defect and the right ventricular outflow tract (RVOT) incision to relieve RVOT obstruction. Risk factors for ventricular arrhythmia disclosed in previous studies include hemodynamic factors such as severe pulmonary regurgitation (PR) and increased left ventricle end-diastolic pressure and electrophysiologic factors such as prolonged QRS duration (3,4). The possible mechanism includes a mechanoelectrical interaction that PR could increase right ventricular loading, which further aggravates QRS prolongation (5). Thus, the depolarization and repolarization inhomogeneity and secondary QT prolongation contribute to the development of ventricular arrhythmia. However, the interaction is complex and difficult to elucidate (6).Recently, several animal models have been proposed to simulate the hemodynamic changes in repaired TOF patients by using pulmonary valvotomy or transannular patch (7-11). Although effective in hemodynamic simulation, the importance of electrophysiological factor was seldom addressed. Thus, these models may not adequately represent the whole clinical scenario of repaired TOF. We therefore created a novel animal model in which RVOT transannular patch, PR creation, and RBBB by radiofrequency ablation would all be present to ...

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Section: Discussionmentioning

confidence: 99%

“…Thus, the depolarization and repolarization inhomogeneity and secondary QT prolongation contribute to the development of ventricular arrhythmia. However, the interaction is complex and difficult to elucidate (6).…”

mentioning

confidence: 99%

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Chiu

Huang

Chang³

et al. 2011

Pediatr Res

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“…Another study suggests moderate correlation between QRS duration and end-diastolic volume (r = 0.6 (p < 0.01)) [41]. Association between prolonged QRS and asynchronous contraction of RVOT in patients with rTOF has been reported [58]. 99% of 92 patients with previously repaired TOF from the study conducted by Babu-Narayan et al presented with fibrotic tissue in the free wall of RVOT detected by late gadolinium enhancement CMR [59].…”

Section: Qrs Prolongationmentioning

confidence: 96%

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Grigaliūnas

Gumbienė

Valevičienė

et al. 2015

Seminars in Cardiovascular Medicine

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SummaryTetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart defect. Over the last century, the life expectancy of TOF patients has significantly improved. This, however, has brought new challenges both to patients and their health-care providers, the main of them being late arrhythmia. Ironically, late arrhythmia is predominantly generated due to the fibrotic scars caused by the life-saving surgical repair. Once the first two mainly arrhythmia-free decades after the repair pass, the risk of developing late arrhythmia and, therefore, SCD becomes substantial. Consequently, young adults with repaired Tetralogy of Fallot (rTOF) require careful outpatient monitoring.There have been many attempts to predict the risk of life-threatening arrhythmia in rTOF patients. This has led to the defining of various risk factors, ranging from the widely used QRS prolongation to novel predictors, derived from cardiac magnetic resonance (CMR) based anatomical findings (left ventricular dyssynchrony indexes, right ventricular output tract akinetic length, right ventricular mass-to-volume ratio). The latter predictors have recently established CMR as a tool of high significance in evaluation of rTOF patients.Although the role of Holter monitoring findings in rTOF patient-assessment remains unclear, it may be useful in those who are 25 years and older. Implantable cardioverter-defibrillator (ICD) implantation is the first-line treatment for secondary prevention of sudden cardiac death (SCD). rTOF patients suffer from the highest rate of inappropriate and the lowest rate of appropriate ICD shocks, when compared to other congenital heart diseases. As a consequence, ICD implantation for primary SCD prevention should be carefully weighed. Catheter-based ablation therapy leads to high rate of initial success when abolishing monomorphic ventricular tachycardia and intra-atrial reentrant tachycardia, however recurrence rates remain high. Seminars in Cardiovascular Medicine

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“…1,2 Abnormalities in the temporal pattern of RV mechanical activation have been proposed as one of the determinants of RV dysfunction in patients with surgically repaired congenital heart disease (CHD). 3, 4 Cardiac resynchronization therapy (CRT) has shown benefits for patients with CHD and for those with medically refractory RV failure. 5, 6 It can compensate for electrical and mechanical dyssynchrony in patients who have intraventricular conduction and mechanical delay.…”

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confidence: 99%

Temporal Sequential Pattern of Right Ventricular Free Wall Contraction in Normal Children

Hayabuchi

Ono

Homma

et al. 2017

Circ J

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

Cited by 122 publications

References 37 publications

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

The Role of Mechanical-Electrical Interaction in Ventricular Arrhythmia: Evidence From a Novel Animal Model for Repaired Tetralogy of Fallot

Late arrhythmia in patients with repaired tetralogy of Fallot: who is at risk?

Temporal Sequential Pattern of Right Ventricular Free Wall Contraction in Normal Children

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