Back to Search
Start Over
Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement.
- Source :
-
Clinical cardiology [Clin Cardiol] 2017 Aug; Vol. 40 (8), pp. 591-596. Date of Electronic Publication: 2017 Apr 10. - Publication Year :
- 2017
-
Abstract
- Background: Patients with tetralogy of Fallot (TOF) have increased risk of atrial arrhythmias.<br />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.<br />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.<br />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.<br />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.<br /> (© 2017 Wiley Periodicals, Inc.)
- Subjects :
- Adolescent
Adult
Atrial Flutter diagnosis
Atrial Flutter physiopathology
Child
Electrocardiography, Ambulatory
Electrophysiologic Techniques, Cardiac
Exercise Test
Female
Humans
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Perioperative Period
Pulmonary Valve physiopathology
Retrospective Studies
Risk Factors
Tachycardia, Reciprocating diagnosis
Tachycardia, Reciprocating physiopathology
Tetralogy of Fallot complications
Tetralogy of Fallot diagnosis
Tetralogy of Fallot physiopathology
Time Factors
Treatment Outcome
Young Adult
Atrial Flutter etiology
Heart Valve Prosthesis Implantation adverse effects
Pulmonary Valve surgery
Tachycardia, Reciprocating etiology
Tetralogy of Fallot therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1932-8737
- Volume :
- 40
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Clinical cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 28394443
- Full Text :
- https://doi.org/10.1002/clc.22707