title: Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement.
abstract: BACKGROUND
  Patients with tetralogy of Fallot (TOF) have increased risk of atrial arrhythmias.
  
  
  OBJECTIVE
  A measure of atrial dispersion, the P-wave vector magnitude (Pvm), can identify patients at risk for perioperative atrial flutter (AFL) or intra-atrial re-entrant tachycardia (IART) in a large TOF cohort.
  
  
  METHODS
  We performed a blinded, retrospective analysis of 158 TOF patients undergoing pulmonary valve replacement between 1997 and 2015. History of AFL/IART was documented using electrocardiogram, Holter monitor, exercise stress test, implanted cardiac device, and electrophysiology study. P-R intervals, Pvm, QRS duration, and QRS vector magnitude were assessed from resting sinus-rhythm 12-lead electrocardiograms and identification of those with AFL/IART was determined.
  
  
  RESULTS
  Fourteen patients (8.9%) were found to have AFL/IART. Pvm, QRS duration, and QRS vector magnitude significantly differentiated those with AFL/IART from those without on univariate analysis: 0.09 ± 0.04 vs 0.18 ± 0.07 mV, 161.3 ± 21.9 vs 137.7 ± 31.4 ms, and 1.2 (interquartile range, 1.0-1.2) vs 1.6 mV (1.0-2.3), respectively (P < 0.05 for each). The Pvm had the highest area under the ROC curve (0.88) and was the only significant predictor on multivariate analysis, with odds ratio of 0.02 (95% confidence interval: 0.01-0.53). P-R duration, MRI volumes, and right-heart hemodynamics did not significantly differentiate those with vs those without AFL/IART.
  
  
  CONCLUSIONS
  In TOF patients undergoing pulmonary valve replacement, Pvm has significant value in predicting those with perioperative AFL/IART. These clinical features may help further evaluate TOF patients at risk for perioperative atrial arrhythmias. Prospective studies are warranted.
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.|Department of Cardiology, University of Colorado, Aurora.|Division of Cardiovascular Sciences, Lund University, Sweden.|Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cortez
authors.affiliation: Division of Cardiovascular Sciences, Lund University, Sweden.
authors.forename: Waseem
authors.initials: W
authors.lastname: Barham
authors.affiliation: Department of Cardiology, Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Emily
authors.initials: E
authors.lastname: Ruckdeschel
authors.affiliation: Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Nandita
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Department of Cardiology, CHOC Children's, Orange, California.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: McCanta
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.|Department of Cardiology, University of Colorado, Aurora.
authors.forename: Johannes
authors.initials: J
authors.lastname: von Alvensleben
authors.affiliation: Department of Cardiology, University of Colorado, Aurora.
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.|Department of Cardiology, University of Colorado, Aurora.|Department of Cardiology, University of Colorado Denver School of Medicine.
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Collins
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.|Department of Cardiology, University of Colorado, Aurora.|Department of Cardiology, University of Colorado Denver School of Medicine.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kay
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.|Department of Cardiology, University of Colorado, Aurora.|Department of Cardiology, University of Colorado Denver School of Medicine.
authors.forename: Sonali
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Cardiology, University of Colorado, Aurora.
authors.forename: Duy T
authors.identifier: http://orcid.org/0000-0001-6570-6010
authors.initials: DT
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005080:Exercise Test; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D059035:Perioperative Period; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D054139:Tachycardia, Reciprocating / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013771:Tetralogy of Fallot / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atrial Flutter; Intra-atrial Re-entrant Tachycardia; Tetralogy of Fallot; Vectorcardiography