@Article{CHD.2020.011712,
AUTHOR = {Matthias Schneider, Miriam Moser, Varius Dannenberg, Andreas Mangold, Robert Schönbauer, Christian Hengstenberg, Harald Gabriel},
TITLE = {QRS Duration and Outcome Late after Repair of Tetralogy of Fallot:  Neurohormonal Activation Differentiates between Mechanical and Electrical  Dyssynchrony},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {15},
YEAR = {2020},
NUMBER = {1},
PAGES = {51--58},
URL = {http://www.techscience.com/schd/v15n1/39377},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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.
<b>Conclusion:</b> 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.},
DOI = {10.32604/CHD.2020.011712}
}