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ECG Changes in Tetralogy of Fallot : Association with Right Ventricular Function, Early Age of Repair and Prematurity

Bhat, Misha LU orcid ; Malm, Torsten LU ; Nordenstam, Felicia ; Hanséus, Katarina LU ; Rosenkvist, Carl Johan and Liuba, Petru LU (2026) In Pediatric Cardiology
Abstract

Tetralogy of Fallot (TOF) patients are at risk for long-term adverse events. Electrocardiogram (ECG) abnormalities may reflect ventricular maladaptation and predict complications. We investigated whether ECG changes correlated with cardiac magnetic resonance imaging (CMR) measures of right ventricular (RV) function and their prevalence in less mature myocardium (prematurity or early repair). This retrospective study included 219 TOF patients operated between 2000-01-01 and 2018-12-31. Parameters analyzed included PQ interval, QRS duration, dispersion, fragmentation, QTc, JTc, and right bundle branch block (RBBB) at predefined time points. In patients undergoing pulmonary valve replacement (PVR) with available CMR, measures of RV size... (More)

Tetralogy of Fallot (TOF) patients are at risk for long-term adverse events. Electrocardiogram (ECG) abnormalities may reflect ventricular maladaptation and predict complications. We investigated whether ECG changes correlated with cardiac magnetic resonance imaging (CMR) measures of right ventricular (RV) function and their prevalence in less mature myocardium (prematurity or early repair). This retrospective study included 219 TOF patients operated between 2000-01-01 and 2018-12-31. Parameters analyzed included PQ interval, QRS duration, dispersion, fragmentation, QTc, JTc, and right bundle branch block (RBBB) at predefined time points. In patients undergoing pulmonary valve replacement (PVR) with available CMR, measures of RV size and function were compared with ECG variables. Early repair was defined as < 3 months and prematurity < 37 weeks’ gestation. Median age at follow-up was 12.3 years (IQR, 8.4;17), and 4.9 months (IQR, 3.4;6.9) at primary repair. PQ interval correlated with RV end-diastolic, stroke and regurgitant volume, whereas RBBB correlated with larger RV. Forty-five patients (21%) underwent early repair (median 2.3 months [IQR 1.3;2.7]) with no significant ECG differences. Forty-one patients (20%) were premature. Premature patients were older at repair versus term (5.8 months [IQR 4.1;7.3] vs. 4.5 months [IQR 3.0;6.3], p = 0.001) but weighed less (5.6 kg [SD 1.2] vs. 6.5 kg [SD 1.7], p = 0.001). PQ interval was shorter in premature patients at multiple time points. Neither prematurity nor early repair were associated with increased reintervention or PVR. These findings support an association between PQ interval and RV volume load. Shorter PQ intervals with prematurity may reflect stiff myocardium, with unknown long-term implications.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Cardiac magnetic resonance imaging, Early repair, Electrocardiogram, Prematurity, Remodeling, Tetralogy of Fallot
in
Pediatric Cardiology
publisher
Springer
external identifiers
  • pmid:42095915
  • scopus:105038188171
ISSN
0172-0643
DOI
10.1007/s00246-026-04283-3
language
English
LU publication?
yes
id
f43e7565-9460-4a21-8320-e980c730ef7c
date added to LUP
2026-08-25 14:47:40
date last changed
2026-09-08 15:34:51
@article{f43e7565-9460-4a21-8320-e980c730ef7c,
  abstract     = {{<p>Tetralogy of Fallot (TOF) patients are at risk for long-term adverse events. Electrocardiogram (ECG) abnormalities may reflect ventricular maladaptation and predict complications. We investigated whether ECG changes correlated with cardiac magnetic resonance imaging (CMR) measures of right ventricular (RV) function and their prevalence in less mature myocardium (prematurity or early repair). This retrospective study included 219 TOF patients operated between 2000-01-01 and 2018-12-31. Parameters analyzed included PQ interval, QRS duration, dispersion, fragmentation, QTc, JTc, and right bundle branch block (RBBB) at predefined time points. In patients undergoing pulmonary valve replacement (PVR) with available CMR, measures of RV size and function were compared with ECG variables. Early repair was defined as &lt; 3 months and prematurity &lt; 37 weeks’ gestation. Median age at follow-up was 12.3 years (IQR, 8.4;17), and 4.9 months (IQR, 3.4;6.9) at primary repair. PQ interval correlated with RV end-diastolic, stroke and regurgitant volume, whereas RBBB correlated with larger RV. Forty-five patients (21%) underwent early repair (median 2.3 months [IQR 1.3;2.7]) with no significant ECG differences. Forty-one patients (20%) were premature. Premature patients were older at repair versus term (5.8 months [IQR 4.1;7.3] vs. 4.5 months [IQR 3.0;6.3], p = 0.001) but weighed less (5.6 kg [SD 1.2] vs. 6.5 kg [SD 1.7], p = 0.001). PQ interval was shorter in premature patients at multiple time points. Neither prematurity nor early repair were associated with increased reintervention or PVR. These findings support an association between PQ interval and RV volume load. Shorter PQ intervals with prematurity may reflect stiff myocardium, with unknown long-term implications.</p>}},
  author       = {{Bhat, Misha and Malm, Torsten and Nordenstam, Felicia and Hanséus, Katarina and Rosenkvist, Carl Johan and Liuba, Petru}},
  issn         = {{0172-0643}},
  keywords     = {{Cardiac magnetic resonance imaging; Early repair; Electrocardiogram; Prematurity; Remodeling; Tetralogy of Fallot}},
  language     = {{eng}},
  publisher    = {{Springer}},
  series       = {{Pediatric Cardiology}},
  title        = {{ECG Changes in Tetralogy of Fallot : Association with Right Ventricular Function, Early Age of Repair and Prematurity}},
  url          = {{http://dx.doi.org/10.1007/s00246-026-04283-3}},
  doi          = {{10.1007/s00246-026-04283-3}},
  year         = {{2026}},
}