title: Electrical remodeling following percutaneous pulmonary valve implantation.
abstract: Sudden cardiac death in congenital heart disease is related to increased right ventricular end-diastolic volume (RVEDV), abnormalities of QRS duration, and QRS, JT, and QT dispersions. Surgical pulmonary valve replacement and percutaneous pulmonary valve implantation (PPVI) decrease RVEDV, but the effects of PPVI on surface electrocardiographic parameters are unknown. PPVI represents a pure model of RV mechanical and electrophysiologic changes after replacement. This prospective study sought to determine the effects of PPVI on surface electrocardiographic parameters: Ninety-nine PPVI procedures in patients with congenital heart disease (23.1 ± 10 years of age) were studied before, after, and 1 year after PPVI with serial electrocardiograms and echocardiogram/magnetic resonance images. Forty-three percent had pulmonary stenosis, 27% pulmonary regurgitation (PR), and 29% mixed lesions. In those with predominantly PR (n = 26), QRS duration decreased significantly (135 ± 27 to 128 ± 29 ms, p = 0.007). However, in the total cohort no significant change in QRS duration at 1 year was observed (137 ± 29 to 134 ± 29 ms). Corrected QT interval and QRS, QT, and JT dispersions significantly decreased at 1 year (p ≤0.001). RVEDV correlated with preprocedure QRS duration (r = 0.34, p <0.002) but there was no correlation after PPVI. In conclusion, this is the first study reporting electrical remodeling after isolated PPVI and it confirms that decreases in QRS duration occur after PPVI in PR, as reported for equivalent surgical cohorts. Further, increased homogeneity of repolarization in combination with improved conduction may decrease arrhythmic events in congenital cardiac patients with pulmonary valvular disease.
authors.affiliation: Departments of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, United Kingdom. carla.plymen@uclh.nhs.uk
authors.forename: Carla M
authors.initials: CM
authors.lastname: Plymen
authors.forename: Aidan P
authors.initials: AP
authors.lastname: Bolger
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.forename: Johannes
authors.initials: J
authors.lastname: Nordmeyer
authors.forename: Twin Yen
authors.initials: TY
authors.lastname: Lee
authors.forename: Alamgir
authors.initials: A
authors.lastname: Kabir
authors.forename: Louise
authors.initials: L
authors.lastname: Coats
authors.forename: Seamus
authors.initials: S
authors.lastname: Cullen
authors.forename: Fiona
authors.initials: F
authors.lastname: Walker
authors.forename: John E
authors.initials: JE
authors.lastname: Deanfield
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Philipp
authors.initials: P
authors.lastname: Bonhoeffer
authors.forename: Pier D
authors.initials: PD
authors.lastname: Lambiase
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006349:Heart Valve Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011664:Pulmonary Valve; D055815:Young Adult