Key result
In patients late after tetralogy of Fallot repair, undocumented palpitations were associated with significantly larger right atrial size (58.2 vs 50.5 mm, P=0.02) and increased P-wave dispersion.
Why the study?
Are specific echocardiographic and electrocardiographic parameters associated with undocumented arrhythmias (palpitations) in adults late after repair of tetralogy of Fallot?
Observational (n=52)
Are specific echocardiographic and electrocardiographic parameters associated with undocumented arrhythmias (palpitations) in adults late after repair of tetralogy of Fallot?
In adults late after tetralogy of Fallot repair, undocumented palpitations are associated with increased right atrial size and P-wave dispersion, suggesting they are most likely supraventricular tachycardias.
May aid arrhythmia risk stratification in repaired tetralogy of Fallot; leaves open prospective validation of right atrial size.
AIMS: Arrhythmias occurring late after repair of tetralogy of Fallot (ToF) are common. Due to the risk of sudden cardiac death, attention is focused towards ventricular tachycardias (VT). The aims of this study were to determine the clinical profile of patients with known benign and malignant arrhythmias and to assess patients with palpitations without documented arrhythmias. METHODS AND RESULTS: Fifty-two patients with prior ToF repair were included in this study (mean follow-up: 18+/-7.3 years). Echocardiographic measurements such as left ventricular ejection fraction, left and right atrial (LA and RA) diameters, left and right ventricular diameters (LVEDD and RVEDD), pulmonary and tricuspid regurgitation (TI and PI) and electrocardiographic parameters such as QRS duration, P-wave duration, P-wave dispersion were obtained and compared in patients with and without a history of palpitations. The same comparisons were performed between patients with documented supraventricular tachycardias (SVT) and VT. Twenty-seven of 52 patients had a clinical history of palpitations. The remaining 25 patients served as controls. Eleven patients had documented SVT and 6 patients had documented VT. In patients with documented SVT, the RA size and the QRS durations were significantly higher than in the controls (RA: 55.3+/-5.6 vs. 47.4+/-4.8 mm, P=0.03, QRS: 160.0+/-25.9 vs. 131.8+/-26.1 ms, P=0.01). In patients with VT, the LVEDD, LA, and QRS durations showed significantly higher values compared with the control patients (LVEDD: 53.5+/-4.7 vs. 45.6+/-6.8 mm; LA: 56.0+/-3.4 vs. 48.5+/-4.8 mm, P=0.01; QRS: 169.5+/-29.7 ms vs. 131.8+/-26.1 ms; P=0.001). The only significant differences between patients with and without palpitations were the RA size (58.2+/-3.9 vs. 50.5+/-5.2 mm, P=0.02) and the P-wave dispersion (26.8+/-15.2 vs. 16.6+/-4.3 ms, P=0.04). CONCLUSION: Our present data suggest that undocumented arrhythmias are most likely SVTs and are associated with increased RA size.
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Roşianu et al. (2008) conducted an observational in Prior repair of tetralogy of Fallot (ToF) (n=52). History of palpitations vs. No history of palpitations was evaluated on Right atrial (RA) size (mm) (p=0.02). In patients late after tetralogy of Fallot repair, undocumented palpitations were associated with significantly larger right atrial size (58.2 vs 50.5 mm, P=0.02) and increased P-wave dispersion.
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