Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement
| Autor: | Nandita Sharma, William H. Sauer, Joseph Kay, Sonali S. Patel, Emily Ruckdeschel, Anthony C. McCanta, Daniel Cortez, Kathryn K. Collins, Johannes C. von Alvensleben, Duy T. Nguyen, Waseem Barham |
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| Rok vydání: | 2017 |
| Předmět: |
Tachycardia
medicine.medical_specialty Holter monitor 030204 cardiovascular system & hematology 03 medical and health sciences QRS complex Electrophysiology study 0302 clinical medicine Internal medicine medicine cardiovascular diseases 030212 general & internal medicine Tetralogy of Fallot medicine.diagnostic_test business.industry General Medicine Perioperative medicine.disease medicine.anatomical_structure Pulmonary valve cardiovascular system Cardiology medicine.symptom Cardiology and Cardiovascular Medicine business Atrial flutter |
| Zdroj: | Clinical Cardiology. 40:591-596 |
| ISSN: | 0160-9289 |
| DOI: | 10.1002/clc.22707 |
| Popis: | 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±31.4ms, 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. |
| Databáze: | OpenAIRE |
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