Long-Term Electrocardiographic Follow-Up after Repair of Tetralogy of Fallot

• Published in: Annals of noninvasive electrocardiology 2011-10, Vol.16 (4), p.336-343
• Main Authors: Massin, Martial M., Malekzadeh-Milani, Sophie G., Schifflers, Stefan, Dessy, Hugues, Verbeet, Thierry
• Format: Article
• Language: English
• Subjects: Arrhythmias, Cardiac - epidemiology; Child; Child, Preschool; Comorbidity; conduction disorders; congenital heart disease; Electrocardiography; Female; follow-up; Follow-Up Studies; Heart Conduction System - physiopathology; Humans; Infant; Infant, Newborn; Male; Original; Postoperative Period; Prostheses and Implants; tetralogy of Fallot; Tetralogy of Fallot - epidemiology; Tetralogy of Fallot - physiopathology; Tetralogy of Fallot - surgery
• ISSN: 1082-720X; 1542-474X
• DOI: 10.1111/j.1542-474X.2011.00460.x

Background: Fallot patients with conduction disturbances are prone to sudden cardiac death. However, knowledge about long‐term electrocardiographic changes after Fallot repair is limited. Methods: Measurements were performed on electrocardiograms recorded preoperatively, postoperatively, and during annual follow‐up in 35 Fallot patients included in three groups: G1 if they received no patch (n = 7), G2 if they received a transannular patch (n = 13), and G3 if they received a pulmonary homograft (n = 15). Results: PR interval increased over the study period in all groups (Z‐score: from 0.9 ± 1.1 to 1.3 ± 0.9 in G1, 0.9 ± 1.2 to 1.7 ± 1.6 in G2, and 0.7 ± 0.7 to 1.4 ± 1.3 in G3). The QRS duration increased during the follow‐up at a rate of 1.78 msec/year in G1, 2.34 msec/year in G2 despite pulmonary valve replacement in 10 patients, and 1.81 msec/year in G3 despite conduit replacement in 9. At the later follow‐up, the QRS duration was significantly increased (Z= 4.5 ± 3.6 in G1, 5.7 ± 1.4 in G2, and 4.6 ± 1.9 in G3). One patient in each group had QRS duration of 170 msec or longer and the one in G3 had a history of serious ventricular arrhythmia. Three patients had a QTc duration above 460 msec. Conclusions: Progressive conduction disorders are noted during long‐term follow‐up in Fallot patients who received transannular patch but also in those who received no patch or a pulmonary homograft. It suggests that volume overloading related to the transannular patch but also pressure overloading and myocardial injury related to surgery contribute to their development. Ann Noninvasive Electrocardiol 2011;16(4):336–343