Relation Between QRS Duration, Right Ventricular Func-tion and Left Ventricular Dyssinchrony in Patients After Surgical Correction of Tetralogy Fallot
Abstract
Background. QRS duration has long been established as a strong predic-tor of sudden cardiac death in patients after surgical correction of Tetral-ogy of Fallot (TOF). Several factors has been correlated to QRS duration, i.e severity of pulmonal regurgitation and right ventricular volume after TOF correction. But there is no established relation between right ven-tricular function and QRS duration after surgical correction TOF.Objectives. We aimed to investigate the relation between QRS duration and right ventricular function and whether patients after TOF repair with right bundle branch block have left ventricular dissynchrony.
Methods.50 patients with repaired TOF were studied. Right ventricular function were derived from tissue Doppler imaging Tei index. Left ven-tricular dissynchrony were derived from tissue Doppler imaging. The time interval between the onset of QRS complex and the onset of systolic ejec-tion was measured for six left ventricular basal wall, i.e septal, lateral, anteroseptal, posterior, anterior and inferior wall. Mechanical delay from septal to lateral wall, antero-septal to posterior wall and anterior to infe-rior wall was calculated. Measured data were correlated with QRS dura-tion.
Results.There was relation between QRS duration and right ventricular function (P = 0.028, r = 0.44). Ten (20%) of the examined patients after TOF repair had LV dissnynchrony particularly in patients with RBBB and prolonged QRS duration (160 ± 9 ms).
Conclusions.There is correlation between right ventricular function and QRS duration. Left ventricular dissynchrony may exist in patients after TOF repair with RBBB.
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References
Nollert G, Fischlein T, Bouterwek S, Bohmer C, Klinner W, Reichart B. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol. 1997;30:1374-1383.
Hamada H, Terai M, Jibiki T, Nakamura T, Gatzoulis MA, Niwa K. Influence of early repair of tetralogy of fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach. Cardiol Young. 2002;12:345-351.
Murphy JG, Gersh BJ, Mair DD, Fuster V, McGoon MD, Ilstrup DM, McGoon DC, Kirklin JW, Danielson GK. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med. 1993;329:593-599.
Deanfield JE, McKenna WJ, Presbitero P, England D,Graham GR, Hallidie-Smith K. Ventricular arrhythmia in unrepaired and repaired tetralogy of Fallot. Relation to age, timing of repair, and haemodynamic status. Br Heart J. 1984;52:77-81.
Gatzoulis MA, Clark AL, Cullen S, Newman CG, Redington AN. Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot. Restrictive physiology predicts
superior exercise performance. Circulation. 1995;91:1775-1781.
Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, Rosenthal M, Nakazawa M, Moller JH, Gillette PC, Webb GD, Redington AN. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000;356:975-981.
Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart. 2000;84:416-420.
Helbing WA, Roest AA, Niezen RA, Vliegen HW, Hazekamp MG, Ottenkamp J, de Roos A, van der Wall EE. ECG predictors of ventricular arrhythmias and biventricular size and wall mass
in tetralogy of Fallot with pulmonary regurgitation. Heart. 2002;88:515-519.
Therrien J, Siu SC, Harris L, Dore A, Niwa K, Janousek J, Williams WG, Webb G, Gatzoulis MA. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation. 2001;103:2489-2494.
van Huysduynen BH, van Straten A, Swenne CA, Maan AC, van Eck HJ, Schalij MJ, van der Wall EE, de Roos A, Hazekamp MG, Vliegen HW. Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume. Eur Heart J. 2005;26:928-932.
Therrien J, Siu SC, McLaughlin PR, Liu PP, Williams WG, Webb GD. Pulmonary valve replacement in adults late after repair of tetralogy of fallot: are we operating too late? J Am Coll Cardiol. 2000;36:1670-1675.
Norozi K, Buchhorn R, Bartmus D, Alpers V, Arnhold JO, Schoof S, Zoege M, Binder L, Geyer S, Wessel A. Elevated brain natriuretic peptide and reduced exercise capacity in adult patients operated on for tetralogy of fallot is due to biventricular dysfunction as determined by the myocardial performance index. Am J Cardiol. 2006;97:1377-1382.
Gelband H, Waldo AL, Kaiser GA, Bowman FO, GMal, L., AL. Etiology of Right Bundle-Branch Block in Patients Undergoing Total Correction of Tetralogy of Fallot. Circulation. 1971;44:1022.
Horowitz LN, Simson MB, Spear JF, Josephson ME, Moore EN, Alexander JA, Kastor JA, Edmunds LH, Jr. The mechanism of apparent right bundle branch block after transatrial repair of tetralogy of Fallot. Circulation. 1979;59:1241-1252.
Abd El Rahman MY, Hui W, Yigitbasi M, Dsebissowa F, Schubert S, Hetzer R, Lange PE, Abdul-Khaliq H. Detection of left ventricular asynchrony in patients with right bundle branch block after repair of tetralogy of Fallot using tissue-Doppler imaging-derived strain. J Am Coll Cardiol. 2005; 45:915-921.
Dubin AM, Feinstein JA, Reddy M, Hanley FL, Van Hare GF, Rosenthal DN. Electrical Resynchronization. A Novel Therapy for the Failing right Ventricle. Circulation. 2003;107:2287-2289.
Cullen S, Celermajer DS, Franklin RC, Hallidie-Smith KA, Deanfield JE. Prognostic significance of ventricular arrhythmia after repair of tetralogy of Fallot: a 12-year prospective study. J Am Coll Cardiol. 1994;23:1151-1155.
Gatzoulis MA, Till JA, Somerville J, Redington AN. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation. 1995;92:231-237.
Frigiola A, Redington AN, Cullen S, Vogel M. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation. 2004;110:II153-II157.
Goldman MJ. Normal Electrocardiographic Complexes. In: Principles of Clinical Electrocardiography. 1979. Lange Medical Publications, San Francisco.
Giroud D, Zimmermann M, Adamec R, Oberhansli I, Friedli B. Ventricular late potentials and spontaneous ventricular arrhythmias after surgical repair of tetralogy of Fallot: do they have prognostic value? Br Heart J. 1994;72:580-583.
Arsan S, Yorgancioglu C, Pasaoglu I, Erbas B, Bozer AY. The influence of pulmonary insufficiency on ventricular function following total correction of Fallot’s tetralogy: evaluation using radionuclide ventriculography and clinical findings. Turk J Pediatr. 1993;35:323-331.
Norgard G, Gatzoulis MA, Moraes F, Lincoln C, Shore DF, Shinebourne EA, Redington AN. Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot. Implications for long-term outcome. Circulation. 1996;94:3276-3280.
Munkhammar P, Cullen S, Jogi P, De Leval M, Elliott M, Norgard G. 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. 1998;32:1083-1087.
Nabar A. Event Recorder Excerpts from Electrophysiology Sessions at the European Society of Cardiology Congress 2002 - Berlin. Indian Pacing and Electrophysiology Journal. 2003;3:41-43.
Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr. 1997;10:169-178.
Eidem BW, O’leary PW, Tei C, Seward JB. Usefulness of the myocardial Performance Index for Assessing Right Ventricular Function in Congenital Heart Disease. Am J Cardiol. 2000;86:654-658.
Curtiss EI, Reddy PS, O’Toole JD, Shawer JA. Alterations of right ventricular systolic time intervals by choronic pressure and volume overloading. Circulation. 1976;53:997-1003.
Harada K, Tamura M, Toyono M, Yasuoka K. Comparison of the Right Ventricular Tei Index by Tissue Doppler Imaging to That Obtained by Pulsed Doppler in Children Without Heart Disease. Am J Cardiol. 2002;90:566-569.
Borzoee M, Kheirandish Z. Doppler-Derived Myocardial Performance Index in Healthy Children in Shiraz ¬. Iran J Med Sci. 2004;29:85-89.
Deanfield J, McKenna W,Rowland E. Local abnormalities of right ventricular depolarization after repair of tetralogy of Fallot: a basis for ventricular arrhythmia. Am J Cardiol. 1985;55:522-525.
Ghai A, Silversides C, Harris L, Webb GD, Siu SC, Therrien J. Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol. 2002;40:1675-1680.
Uretzky G, Puga FJ, Danielson GK, Hagler DJ, McGoon DC. Reoperation after correction of tetralogy of Fallot. Circulation. 1982;66:I202-I208.
Carvalho JS, Shinebourne EA, Busst C, Rigby ML, Redington AN. Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation. Br Heart J. 1992;67:470-473.
Garrigue S, Reuter S, Labeque JN, et al. Usefulness of biventricular pacing in patients with congestive heart failure and right bundle branch bloc. Am J Cardiol. 2001;88:1436-1441.
Hamada H, Terai M, Jibiki T, Nakamura T, Gatzoulis MA, Niwa K. Influence of early repair of tetralogy of fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach. Cardiol Young. 2002;12:345-351.
Murphy JG, Gersh BJ, Mair DD, Fuster V, McGoon MD, Ilstrup DM, McGoon DC, Kirklin JW, Danielson GK. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med. 1993;329:593-599.
Deanfield JE, McKenna WJ, Presbitero P, England D,Graham GR, Hallidie-Smith K. Ventricular arrhythmia in unrepaired and repaired tetralogy of Fallot. Relation to age, timing of repair, and haemodynamic status. Br Heart J. 1984;52:77-81.
Gatzoulis MA, Clark AL, Cullen S, Newman CG, Redington AN. Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot. Restrictive physiology predicts
superior exercise performance. Circulation. 1995;91:1775-1781.
Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, Rosenthal M, Nakazawa M, Moller JH, Gillette PC, Webb GD, Redington AN. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000;356:975-981.
Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart. 2000;84:416-420.
Helbing WA, Roest AA, Niezen RA, Vliegen HW, Hazekamp MG, Ottenkamp J, de Roos A, van der Wall EE. ECG predictors of ventricular arrhythmias and biventricular size and wall mass
in tetralogy of Fallot with pulmonary regurgitation. Heart. 2002;88:515-519.
Therrien J, Siu SC, Harris L, Dore A, Niwa K, Janousek J, Williams WG, Webb G, Gatzoulis MA. Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation. 2001;103:2489-2494.
van Huysduynen BH, van Straten A, Swenne CA, Maan AC, van Eck HJ, Schalij MJ, van der Wall EE, de Roos A, Hazekamp MG, Vliegen HW. Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume. Eur Heart J. 2005;26:928-932.
Therrien J, Siu SC, McLaughlin PR, Liu PP, Williams WG, Webb GD. Pulmonary valve replacement in adults late after repair of tetralogy of fallot: are we operating too late? J Am Coll Cardiol. 2000;36:1670-1675.
Norozi K, Buchhorn R, Bartmus D, Alpers V, Arnhold JO, Schoof S, Zoege M, Binder L, Geyer S, Wessel A. Elevated brain natriuretic peptide and reduced exercise capacity in adult patients operated on for tetralogy of fallot is due to biventricular dysfunction as determined by the myocardial performance index. Am J Cardiol. 2006;97:1377-1382.
Gelband H, Waldo AL, Kaiser GA, Bowman FO, GMal, L., AL. Etiology of Right Bundle-Branch Block in Patients Undergoing Total Correction of Tetralogy of Fallot. Circulation. 1971;44:1022.
Horowitz LN, Simson MB, Spear JF, Josephson ME, Moore EN, Alexander JA, Kastor JA, Edmunds LH, Jr. The mechanism of apparent right bundle branch block after transatrial repair of tetralogy of Fallot. Circulation. 1979;59:1241-1252.
Abd El Rahman MY, Hui W, Yigitbasi M, Dsebissowa F, Schubert S, Hetzer R, Lange PE, Abdul-Khaliq H. Detection of left ventricular asynchrony in patients with right bundle branch block after repair of tetralogy of Fallot using tissue-Doppler imaging-derived strain. J Am Coll Cardiol. 2005; 45:915-921.
Dubin AM, Feinstein JA, Reddy M, Hanley FL, Van Hare GF, Rosenthal DN. Electrical Resynchronization. A Novel Therapy for the Failing right Ventricle. Circulation. 2003;107:2287-2289.
Cullen S, Celermajer DS, Franklin RC, Hallidie-Smith KA, Deanfield JE. Prognostic significance of ventricular arrhythmia after repair of tetralogy of Fallot: a 12-year prospective study. J Am Coll Cardiol. 1994;23:1151-1155.
Gatzoulis MA, Till JA, Somerville J, Redington AN. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation. 1995;92:231-237.
Frigiola A, Redington AN, Cullen S, Vogel M. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation. 2004;110:II153-II157.
Goldman MJ. Normal Electrocardiographic Complexes. In: Principles of Clinical Electrocardiography. 1979. Lange Medical Publications, San Francisco.
Giroud D, Zimmermann M, Adamec R, Oberhansli I, Friedli B. Ventricular late potentials and spontaneous ventricular arrhythmias after surgical repair of tetralogy of Fallot: do they have prognostic value? Br Heart J. 1994;72:580-583.
Arsan S, Yorgancioglu C, Pasaoglu I, Erbas B, Bozer AY. The influence of pulmonary insufficiency on ventricular function following total correction of Fallot’s tetralogy: evaluation using radionuclide ventriculography and clinical findings. Turk J Pediatr. 1993;35:323-331.
Norgard G, Gatzoulis MA, Moraes F, Lincoln C, Shore DF, Shinebourne EA, Redington AN. Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot. Implications for long-term outcome. Circulation. 1996;94:3276-3280.
Munkhammar P, Cullen S, Jogi P, De Leval M, Elliott M, Norgard G. 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. 1998;32:1083-1087.
Nabar A. Event Recorder Excerpts from Electrophysiology Sessions at the European Society of Cardiology Congress 2002 - Berlin. Indian Pacing and Electrophysiology Journal. 2003;3:41-43.
Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr. 1997;10:169-178.
Eidem BW, O’leary PW, Tei C, Seward JB. Usefulness of the myocardial Performance Index for Assessing Right Ventricular Function in Congenital Heart Disease. Am J Cardiol. 2000;86:654-658.
Curtiss EI, Reddy PS, O’Toole JD, Shawer JA. Alterations of right ventricular systolic time intervals by choronic pressure and volume overloading. Circulation. 1976;53:997-1003.
Harada K, Tamura M, Toyono M, Yasuoka K. Comparison of the Right Ventricular Tei Index by Tissue Doppler Imaging to That Obtained by Pulsed Doppler in Children Without Heart Disease. Am J Cardiol. 2002;90:566-569.
Borzoee M, Kheirandish Z. Doppler-Derived Myocardial Performance Index in Healthy Children in Shiraz ¬. Iran J Med Sci. 2004;29:85-89.
Deanfield J, McKenna W,Rowland E. Local abnormalities of right ventricular depolarization after repair of tetralogy of Fallot: a basis for ventricular arrhythmia. Am J Cardiol. 1985;55:522-525.
Ghai A, Silversides C, Harris L, Webb GD, Siu SC, Therrien J. Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol. 2002;40:1675-1680.
Uretzky G, Puga FJ, Danielson GK, Hagler DJ, McGoon DC. Reoperation after correction of tetralogy of Fallot. Circulation. 1982;66:I202-I208.
Carvalho JS, Shinebourne EA, Busst C, Rigby ML, Redington AN. Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation. Br Heart J. 1992;67:470-473.
Garrigue S, Reuter S, Labeque JN, et al. Usefulness of biventricular pacing in patients with congestive heart failure and right bundle branch bloc. Am J Cardiol. 2001;88:1436-1441.
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How to Cite
Dewayani, R., Siswanto, B., Roebiono, P., Rahajoe, A., Sakidjan, I., & Harimurti, G. (1). Relation Between QRS Duration, Right Ventricular Func-tion and Left Ventricular Dyssinchrony in Patients After Surgical Correction of Tetralogy Fallot. Indonesian Journal of Cardiology, 28(4), 256-266. https://doi.org/10.30701/ijc.v28i4.229
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