Appearance of QRS fragmentation late after Mustard/Senning repair is associated with adverse outcome.
To evaluate if development of fragmented QRS (fQRS) complexes, a marker of inhomogeneous ventricular activation due to myocardial fibrosis, is associated with adverse outcome in adults after Mustard/Senning repair for d-transposition of the great arteries (d-TGA).



Adults with atrial switch repair for d-TGA were selected from the database of a tertiary care hospital. Exclusion criteria were systemic right ventricular (RV) assist device or heart transplantation (HTx) before the age of 16, or fQRS already present at first visit to the Adult Congenital Heart Disease clinic. A blinded expert reader retrospectively analysed all available ECGs after the age of 16 for the presence of fQRS. The appearance of fQRS was modelled for each patient as a time-dependent variable. Cox regression was performed to assess the relationship between covariates and the composite endpoint of cardiovascular mortality, HTx or systemic RV assist device.



Records of 89 patients (34% female, 42% Mustard repair) were analysed. At latest follow-up, fQRS was noted in 26 patients (29%). Over a median follow-up time of 16.9 (IQR 12.6-22.9) years, the composite endpoint occurred in nine patients (10%). In multivariable Cox analysis, appearance of fQRS (HR 14.11; 95% CI 1.42 to 140.12) and development of severe RV dysfunction (HR 11.36; 95% CI 2.08 to 62.17) were significantly associated with the composite endpoint.



Appearance of fQRS complexes on a 12-lead ECG is associated with adverse outcome in adults after atrial switch repair for d-TGA. In this population, fQRS detection might be a promising and easily implementable tool to identify patients at risk for adverse events.
Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Frederik
F
Helsen
Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.|Division of Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
Bert
B
Vandenberk
Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Pieter
P
De Meester
Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Alexander
A
Van De Bruaene
Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Charlien
C
Gabriels
Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Els
E
Troost
Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium.
Marc
M
Gewillig
Division of Clinical Cardiac Surgery, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
Bart
B
Meyns
Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Rik
R
Willems
Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.|Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Werner
W
Budts
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right / Q000502:physiology
Cardiac magnetic resonance (CMR) imaging; Congenital heart disease; Echocardiography; Transposition of the great arteries; Tricuspid valve disease