1. Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement.
- Author
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Cortez, Daniel, Barham, Waseem, Ruckdeschel, Emily, Sharma, Nandita, McCanta, Anthony, von Alvensleben, Johannes, Sauer, William, Collins, Kathryn, Kay, Joseph, Patel, Sonali, and Nguyen, Duy
- Subjects
Atrial Flutter ,Intra-atrial Re-entrant Tachycardia ,Tetralogy of Fallot ,Vectorcardiography ,Adolescent ,Adult ,Atrial Flutter ,Child ,Electrocardiography ,Ambulatory ,Electrophysiologic Techniques ,Cardiac ,Exercise Test ,Female ,Heart Valve Prosthesis Implantation ,Humans ,Logistic Models ,Male ,Multivariate Analysis ,Odds Ratio ,Perioperative Period ,Pulmonary Valve ,Retrospective Studies ,Risk Factors ,Tachycardia ,Reciprocating ,Tetralogy of Fallot ,Time Factors ,Treatment Outcome ,Young Adult - Abstract
BACKGROUND: Patients with tetralogy of Fallot (TOF) have increased risk of atrial arrhythmias. HYPOTHESIS: 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.
- Published
- 2017