Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume.
OBJECTIVE
Late after total correction, Fallot patients with a long QRS duration are prone to serious arrhythmias and sudden cardiac death. Pulmonary regurgitation is a common cause of right ventricular (RV) failure and QRS lengthening. We studied the effects of pulmonary valve replacement (PVR) on QRS duration and RV volume.


RESULTS
Twenty-six consecutive Fallot patients were evaluated both pre-operatively and 6-12 months post-operatively by cardiac magnetic resonance (CMR). In this study, we present the computer-assisted analysis of the standard 12-lead electrocardiograms closest in time to the CMR studies. For the whole group, QRS duration shortened by 6+/-8 ms, from 151+/-30 to 144+/-29 ms (P=0.002). QRS duration decreased in 18 of 26 patients by 10+/-6 ms, from 152+/-32 to 142+/-31 ms. QRS duration remained constant or increased slightly in eight of 26 patients by 3+/-3 ms, from 148+/-27 to 151+/-25 ms. CMR showed a decrease in RV end-diastolic volume from 305+/-87 to 210+/-62 mL (P=0.000004). QRS duration changes correlated with RV end-diastolic volume changes (r=0.54, P=0.01).


CONCLUSIONS
Our study shows that PVR reduces QRS duration. The amount of QRS reduction is related to the success of the operation, as expressed by the reduction in RV end-diastolic volume.
van Huysduynen
Bart Hooft
BH
Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
van Straten
Alexander
A
Swenne
Cees A
CA
Maan
Arie C
AC
van Eck
Henk J Ritsema
HJ
Schalij
Martin J
MJ
van der Wall
Ernst E
EE
de Roos
Albert
A
Hazekamp
Mark G
MG
Vliegen
Hubert W
HW
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000473:pathology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000473:pathology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000150:complications* / Q000473:pathology; D018497:Ventricular Dysfunction, Right / Q000473:pathology