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European Heart Journal Advance Access originally published online on February 16, 2005
European Heart Journal 2005 26(9):928-932; doi:10.1093/eurheartj/ehi140
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume

Bart Hooft van Huysduynen1, Alexander van Straten2, Cees A. Swenne1,*, Arie C. Maan1, Henk J. Ritsema van Eck3, Martin J. Schalij1, Ernst E. van der Wall1, Albert de Roos2, Mark G. Hazekamp4 and Hubert W. Vliegen1

1Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
2Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
3Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
4Department of Paediatric Surgery, Leiden University Medical Center, Leiden, The Netherlands

Received 2 July 2004; revised 5 November 2004; accepted 16 December 2004; online publish-ahead-of-print 16 February 2005.

* Corresponding author. Tel: +31 71 526 1972; fax: +31 84 221 8904. E-mail address: c.a.swenne{at}lumc.nl

See page 863 for the editorial comment on this article (doi:10.1093/eurheartj/ehi206)

Aims Late after total correction, Fallot patients with a long QRS duration are prone to serious arrhythmias and sudden cardiac death. Pulmonary regurgitation is a common cause of right ventricular (RV) failure and QRS lengthening. We studied the effects of pulmonary valve replacement (PVR) on QRS duration and RV volume.

Methods and results Twenty-six consecutive Fallot patients were evaluated both pre-operatively and 6–12 months post-operatively by cardiac magnetic resonance (CMR). In this study, we present the computer-assisted analysis of the standard 12-lead electrocardiograms closest in time to the CMR studies. For the whole group, QRS duration shortened by 6±8 ms, from 151±30 to 144±29 ms (P=0.002). QRS duration decreased in 18 of 26 patients by 10±6 ms, from 152±32 to 142±31 ms. QRS duration remained constant or increased slightly in eight of 26 patients by 3±3 ms, from 148±27 to 151±25 ms. CMR showed a decrease in RV end-diastolic volume from 305±87 to 210±62 mL (P=0.000004). QRS duration changes correlated with RV end-diastolic volume changes (r=0.54, P=0.01).

Conclusion Our study shows that PVR reduces QRS duration. The amount of QRS reduction is related to the success of the operation, as expressed by the reduction in RV end-diastolic volume.

Key Words: Electrocardiography • Magnetic resonance imaging • Tetralogy of Fallot • Pulmonary valve replacement


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