Open AccessNoninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement
Author(s) -
Cortez Daniel,
Barham Waseem,
Ruckdeschel Emily,
Sharma Nandita,
McCanta Anthony C.,
von Alvensleben Johannes,
Sauer William H.,
Collins Kathryn K.,
Kay Joseph,
Patel Sonali,
Nguyen Duy T.
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22707
Subject(s) - medicine , cardiology , qrs complex , tetralogy of fallot , interquartile range , atrial flutter , electrocardiography , perioperative , ventricular tachycardia , confidence interval , atrial fibrillation , anesthesia , heart disease
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.