Long-term electrocardiographic follow-up after repair of tetralogy of Fallot.
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.
Division of Pediatric Cardiology, Queen Fabiola Children's University Hospital, Brussels, Belgium. martial.massin@huderf.be
Martial M
MM
Massin
Sophie G
SG
Malekzadeh-Milani
Stefan
S
Schifflers
Hugues
H
Dessy
Thierry
T
Verbeet
D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D019736:Prostheses and Implants; D013771:Tetralogy of Fallot / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery