| Sub-title | |
| Authors | V Grech N Galea O Aquilina |
| Abstract | Repaired tetralogy of Fallot is usually conducive to a normal and unrestricted lifestyle. However, occasionally, late sudden death occurs due to ventricular tachycardia. This is thought to be due to a combination of factors, including both left and right ventricular dilation that may be associated with valvar incompetence, and residual right ventricular outflow tract obstruction (RVOTO). Several studies have shown that QRS duration >180msec is a very sensitive predictor of life-threatening ventricular arrhythmias. We recalled our tetralogy population (n=57) to identify risk factors for prolonged QRS duration on the resting ECG. Factors examined included history, demographics, symptoms, surgery, CXR, ECG and echocardiography. A significant positive correlation was found between QRS duration and degree of tricuspid regurgitation, degree of RVOTO and left ventricular diastolic dimension (LVEDD). A higher mean QRS duration (not statistically significant) was found in the group that had shunt prior to total repair than the primary repair group (shunted n=12, QRS=120.8msec; unshunted n=45, QRS=136.4msec - p=0.09). No significant differences were found between these two groups except for mean delay to surgery (shunted=1093 months, unshunted=174 months - p<0.0001). Conventionally, symptomatic individuals with tetralogy undergo primary repair if the child is old enough. If deemed too young/small, a shunt is inserted and later repair undertaken once the shunt is outgrown with recurrence of cyanosis. Delay to complete repair after shunt insertion with prolonged left ventricular volume overload may permanently alter left ventricular electro-mechanical properties with QRS prolongation. Earlier elective repair with shunt takedown may be a better option. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | Volume 15 (suppl) |
| Pages | - |
| Date | |
| Link to journal | |
| Key words | risk factor, QRS prolongation, repaired tetralogy of Fallot, congenital heart disease, cardiology, paediatrics |