OBJECTIVES<br />The aim of this study was to analyze whether QRS duration, before and after pulmonary valve replacement (PVR), is related to long-term outcome in patients with tetralogy of Fallot (TOF). <br /><br />BACKGROUND<br />Key factors that determine outcome after PVR in adult TOF patients are largely unknown. Recognition of such factors assists the identification of patients at increased risk of adverse events. <br /><br />METHODS<br />Adults who previously underwent total correction for TOF (n = 90; age 31.4 ± 10.3 years) and required PVR for pulmonary regurgitation were included. The QRS duration was measured pre-operatively and 6 months after PVR. The post-operative changes in QRS duration were calculated. Adverse events (death, re-PVR, ventricular tachycardia, and symptomatic heart failure) were noted during follow-up. <br /><br />RESULTS<br />During 5.5 ± 3.5 years of follow-up, 13 adverse events occurred. The 5-year event-free survival rate was 76% for patients with a pre-operative QRS duration >180 ms and 90% in patients with a QRS duration ≤180 ms (p = 0.037). For patients with a post-operative QRS duration >180 ms, 5-year event-free survival was 71%, whereas it was 91% for patients with a post-operative QRS duration ≤180 ms (p = 0.004). After multivariate correction, a post-operative QRS duration >180 ms (hazard ratio: 3.685, 95% confidence interval: 1.104 to 12.304, p < 0.05) and the absence of a reduction in QRS duration post-PVR (hazard ratio: 6.767, 95% confidence interval: 1.704 to 26.878, p < 0.01), was significantly associated with adverse outcome. <br /><br />CONCLUSIONS<br />Severe QRS prolongation, before or after PVR, and the absence of a reduction in QRS duration after PVR, are major determinants of adverse outcome during long-term follow-up of patients with TOF.
Scherptong, R. W. C., Hazekamp, M. G., Mulder, B. J. M., Wijers, O., Swenne, C. A., van der Wall, E. E., … Vliegen, H. W. (2010). Follow-Up After Pulmonary Valve Replacement in Adults With Tetralogy of Fallot. Journal of the American College of Cardiology, 56(18), 1486–1492. https://doi.org/10.1016/j.jacc.2010.04.058