Open Access

ARTICLE

QRS Duration and Outcome Late after Repair of Tetralogy of Fallot: Neurohormonal Activation Differentiates between Mechanical and Electrical Dyssynchrony

by Matthias Schneider^,*, Miriam Moser, Varius Dannenberg, Andreas Mangold, Robert Schönbauer, Christian Hengstenberg, Harald Gabriel

Department of Internal Medicine II, Medical University of Vienna, Vienna, 1090, Austria

* Corresponding Author: Matthias Schneider. Email:

Congenital Heart Disease 2020, 15(1), 51-58. https://doi.org/10.32604/CHD.2020.011712

Received 26 May 2020; Accepted 11 June 2020; Issue published 17 June 2020

Abstract

Background: Predicting the probability for sudden cardiac death (SCD) and thus evaluation of patients for electrical device therapy and/or ablation is one of the main tasks in clinics for adults with congenital heart disease (ACHD) following repaired tetralogy of Fallot (rTOF) patients. Previous data suggests that QRS complex analysis can help identifying those patients who subsequently suffer from SCD. We hypothesized that a long QRS duration is associated with adverse rhythm events if caused by conduction abnormalities but not if caused by right ventricular remodeling. Methods: A retrospective analysis was performed entailing all rTOF patients who were seen at our ACHD clinic between 01/01/2000 and 12/31/2018. Duration of QRS in the earliest available ECG as well as the earliest available NT-proBNP value were documented. A combined endpoint of mortality and adverse rhythmogenic events during 10-year follow-up was analyzed. Results: A total of 155 patients were included in the analysis, median age was 21 years (interquartile range 18–33), 60 (38.5%) were female. During 10- year follow-up, four (2.6%) patients died, and 7 (4.5%) experienced an adverse rhythmogenic event. The cohort was divided into patients with NT-proBNP < 250 pg/ml (n = 133 patients) and ≥ 250 pg/ml (n = 22 patients). In multivariable Cox regression analysis, duration of QRS was significantly predictive for the combined endpoint in the low NT-proBNP group but not in the high NT-proBNP group. Conclusion: Wide QRS duration accompanied by low NT-proBNP values should receive particular attention in rTOF, as these patients might benefit from close rhythm monitoring and early prevention measures.

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