Accuracy of electrocardiographic and echocardiographic indices in predicting life threatening ventricular arrhythmias in patients operated for tetralogy of Fallot

• Published in: Heart (British Cardiac Society) 1999-06, Vol.81 (6), p.650-655
• Main Authors: Daliento, L, Rizzoli, G, Menti, L, Baratella, M C, Turrini, P, Nava, A, Dalla Volta, S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Cardiac arrhythmia; Child; Child, Preschool; Death, Sudden, Cardiac - etiology; Echocardiography, Doppler; Electrocardiography; Female; Follow-Up Studies; Heart attacks; Humans; Logistic Models; Logistics; Male; Medical sciences; Multivariate analysis; Postoperative Care - methods; Postoperative Complications - diagnosis; Probability; Prognosis; Regression Analysis; ROC Curve; Standard deviation; Statistical analysis; sudden death; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - etiology; tetralogy of Fallot; Tetralogy of Fallot - surgery; Variance analysis; Ventricular Fibrillation - diagnosis; Ventricular Fibrillation - etiology; ventricular tachycardia
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.81.6.650

OBJECTIVE To validate the accuracy of the prognostic significance of non-invasive clinical diagnostic indices as predictors of sustained ventricular tachycardia (sVT) or fibrillation (VF) in patients undergoing repair for tetralogy of Fallot. METHODS One way analysis of variance and pairwise comparison of the values with the Bonferroni correction, logistic multivariate analysis, and ordinal logistic analysis were used to study quantitative electrocardiographic and echocardiographic variables in 66 patients who had undergone surgery for tetralogy of Fallot by ventriculotomy at a mean (SD) age of 11.8 (9.5) years. The mean (SD) period of follow up was 16.1 (5.7) years after surgery. RESULTS Four groups of patients were identified by ECG and 24 hour Holter monitoring: 19 (28.7%) without ventricular arrhythmias, 34 (51.5%) with minor ventricular arrhythmias, seven (10.6%) with non-sustained ventricular tachycardia (nsVT), and six (9.0%) with sVT or VF. One way analysis indicated significant differences in QT dispersion (QTd) and end diastolic volume of the right ventricle (EDVRV) among the groups. Univariate logistic analysis showed EDVRV, QTd, and QRS duration to be significantly associated with sVT or VF. Stepwise multivariate analysis and ordinal logistic analysis showed QTd to be preferable to QRS duration as an indicator, because it was unrelated to EDVRV, and was capable of separating different probability curves for nsVT as opposed to sVT or VF. CONCLUSIONS Stratification of patients undergoing corrective surgery for tetralogy of Fallot and at risk of life threatening arrhythmias is possible by simple and inexpensive means, which provide sensitive and specific indices.