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Bhat M, Malm T, Sjöberg G, Nordenstam F, Hanséus K, Rosenkvist CJ, Liuba P. Longitudinal ECG changes in tetralogy of Fallot and association with surgical repair. Front Cardiovasc Med 2024; 11:1349166. [PMID: 38606378 PMCID: PMC11007042 DOI: 10.3389/fcvm.2024.1349166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Background ECG abnormalities have been linked to adverse changes in right ventricular (RV) morphology and poor clinical outcomes in repaired Tetralogy of Fallot (rTOF). Our aim was to describe how ECG changes progress in early and intermediate follow-up and whether types of surgical strategy at the time of primary repair affected these changes. Methods We studied patients with rTOF born 2000-2018 operated at our institution. Seven time points in relation to primary repair, follow-up, and pulmonary valve replacement (PVR) were identified. Patients correct with valve sparing repair (VSR), trans-annular patch (TAP) including with a monocusp valve (TAP + M) and with at least 3 ECGs were included. PQ interval, QRS duration, dispersion, and fragmentation, QTc duration and dispersion, JTc as well as presence of a right bundle branch block (RBBB) were analyzed. Medical records were reviewed for demographic and surgical data. Results Two hundred nineteen patients with 882 ECGs were analyzed with a median follow-up time of 12.3 years (8.4, 17) with 41 (19%) needing PVR during the study period. QRS duration increased at time of primary repair to discharge from 66 msec (IQR 12) to 129 msec (IQR 27) (p < 0.0001) and at 1- and 6- year follow-up but showed only a modest and temporary decrease after PVR. QTc increased at the time of primary repair as well as prior to PVR. PQ interval showed a small increase at the time of primary repair, was at its highest prior to PVR and decreased with PVR. Type of surgical repair affected mainly QTc and JTc and was consistently longer in the TAP + M group until PVR. In VSR, QTc and JTc were prolonged initially compared to TAP but were similar after 1 year. After PVR, there were no differences in adverse ECG changes between surgical groups. Conclusions PQ interval and QRS duration best correspond to the assumed volume load whereas the relationship with QTc and JTc is more complex, suggesting that these represent more complex remodeling of the myocardium. Before PVR, QTc and JTc are longer in the TAP + M group which may be due to a longer surgical incision.
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Affiliation(s)
- Misha Bhat
- Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torsten Malm
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatric Cardiac Surgery, Pediatric Heart Center, Skane University Hospital, Lund, Sweden
| | - Gunnar Sjöberg
- Department of Pediatric Cardiology, Department of Women’s and Children’s Health Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Felicia Nordenstam
- Department of Pediatric Cardiology, Department of Women’s and Children’s Health Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Hanséus
- Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Petru Liuba
- Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Fairbank T, DeBauge A, Harvey CJ, Jiwani S, Ranka S, Beaver TA, Sheldon SH, Reddy M, Noheria A. Electrocardiographic Z-axis QRS-T voltage-time-integral in patients with typical right bundle branch block - Correlation with echocardiographic right ventricular size and function. J Electrocardiol 2024; 82:73-79. [PMID: 38043477 DOI: 10.1016/j.jelectrocard.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Right bundle branch block (RBBB) can be benign or associated with right ventricular (RV) functional and structural abnormalities. Our aim was to evaluate QRS-T voltage-time-integral (VTI) compared to QRS duration and lead V1 R' as markers for RV abnormalities. METHODS We included adults with an ECG demonstrating RBBB and echocardiogram obtained within 3 months of each other, between 2010 and 2020. VTIQRS and VTIQRST were obtained for 12 standard ECG leads, reconstructed vectorcardiographic X, Y, Z leads and root-mean-squared (3D) ECG. Age, sex and BSA-adjusted linear regressions were used to assess associations of QRS duration, amplitudes, VTIs and lead V1 R' duration/VTI with echocardiographic tricuspid annular plane systolic excursion (TAPSE), RV tissue Doppler imaging S', basal and mid diameter, and systolic pressure (RVSP). RESULTS Among 782 patients (33% women, age 71 ± 14 years) with RBBB, R' duration in lead V1 was modestly associated with RV S', RV diameters and RVSP (all p ≤ 0.03). QRS duration was more strongly associated with RV diameters (both p < 0.0001). AmplitudeQRS-Z was modestly correlated with all 5 RV echocardiographic variables (all p ≤ 0.02). VTIR'-V1 was more strongly associated with TAPSE, RV S' and RVSP (all p ≤ 0.0003). VTIQRS-Z and VTIQRST-Z were among the strongest correlates of the 5 RV variables (all p < 0.0001). VTIQRST-Z.√BSA cutoff of ≥62 μVsm had sensitivity 62.7% and specificity 65.7% for predicting ≥3 of 5 abnormal RV variables (AUC 0.66; men 0.71, women 0.60). CONCLUSION In patients with RBBB, VTIQRST-Z is a stronger predictor of RV dysfunction and adverse remodeling than QRS duration and lead V1 R'.
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Affiliation(s)
- Tyan Fairbank
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Ashley DeBauge
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Christopher J Harvey
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sania Jiwani
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sagar Ranka
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Timothy A Beaver
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America.
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Vandenberk B, Robyns T, Goovaerts G, Claeys M, Helsen F, Van Soest S, Garweg C, Ector J, Van Huffel S, Willems R. Inter- and intra-observer variability of visual fragmented QRS scoring in ischemic and non-ischemic cardiomyopathy. J Electrocardiol 2017; 51:549-554. [PMID: 29275955 DOI: 10.1016/j.jelectrocard.2017.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fragmented QRS (fQRS) on a 12-lead ECG has been linked with adverse outcome. However, the visual scoring of ECGs is prone to inter- and intra-observer variability. METHODS Five observers, two experienced and three novel, assessed fQRS in 712 digital ECGs, 100 were re-evaluated to assess intra-observer variability. Fleiss and Cohen's Kappa were calculated and compared between subgroups. RESULTS The inter-observer variability for assessing fQRS in all leads combined was substantial with a Kappa of 0.651. Experienced observers only had a better agreement with a Kappa of 0.823. Intra-observer variability ranged from 0.736 to 0.880. In the subgroup with ventricular pacing the inter-observer variability was even significantly larger when compared to ECGs with normal QRS duration (Kappa 0.493 vs 0.664, p<0.001). CONCLUSION The visual assessment of QRS fragmentation is prone to inter- and intra-observer variability, mainly influenced by the experience of the observers, the underlying rhythm and QRS morphology.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
| | - Tomas Robyns
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Griet Goovaerts
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; Imec, Leuven, Belgium
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Frederik Helsen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Van Soest
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; Imec, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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