TY - EJOU
AU - Schneider, Matthias
AU - Moser, Miriam
AU - Dannenberg, Varius
AU - Mangold, Andreas
AU - Schönbauer, Robert
AU - Hengstenberg, Christian
AU - Gabriel, Harald
TI - QRS Duration and Outcome Late after Repair of Tetralogy of Fallot: Neurohormonal Activation Differentiates between Mechanical and Electrical Dyssynchrony
T2 - Congenital Heart Disease
PY - 2020
VL - 15
IS - 1
SN - 1747-0803
AB - Background: Predicting the probability for sudden cardiac death
(SCD) and thus evaluation of patients for electrical device therapy and/or ablation
is one of the main tasks in clinics for adults with congenital heart disease (ACHD)
following repaired tetralogy of Fallot (rTOF) patients. Previous data suggests that
QRS complex analysis can help identifying those patients who subsequently suffer
from SCD. We hypothesized that a long QRS duration is associated with adverse
rhythm events if caused by conduction abnormalities but not if caused by right
ventricular remodeling. Methods: A retrospective analysis was performed
entailing all rTOF patients who were seen at our ACHD clinic between 01/01/2000
and 12/31/2018. Duration of QRS in the earliest available ECG as well as the
earliest available NT-proBNP value were documented. A combined endpoint of
mortality and adverse rhythmogenic events during 10-year follow-up was
analyzed. Results: A total of 155 patients were included in the analysis, median
age was 21 years (interquartile range 18–33), 60 (38.5%) were female. During 10-
year follow-up, four (2.6%) patients died, and 7 (4.5%) experienced an adverse
rhythmogenic event. The cohort was divided into patients with NT-proBNP < 250
pg/ml (n = 133 patients) and ≥ 250 pg/ml (n = 22 patients). In multivariable Cox
regression analysis, duration of QRS was significantly predictive for the combined
endpoint in the low NT-proBNP group but not in the high NT-proBNP group.
Conclusion: Wide QRS duration accompanied by low NT-proBNP values should
receive particular attention in rTOF, as these patients might benefit from close
rhythm monitoring and early prevention measures.
KW - TOF; ECG; mortality; NT-proBNP
DO - 10.32604/CHD.2020.011712