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Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement

Cortez, Daniel LU ; Barham, Waseem; Ruckdeschel, Emily; Sharma, Nandita; McCanta, Anthony C.; von Alvensleben, Johannes; Sauer, William H.; Collins, Kathryn K.; Kay, Joseph and Patel, Sonali, et al. (2017) In Clinical Cardiology 40(8). p.591-596
Abstract

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... (More)

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.

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publication status
published
subject
keywords
Atrial Flutter, Intra-atrial Re-entrant Tachycardia, Tetralogy of Fallot, Vectorcardiography
in
Clinical Cardiology
volume
40
issue
8
pages
591 - 596
publisher
Wiley-Blackwell
external identifiers
  • scopus:85017410719
  • wos:000407609400013
ISSN
0160-9289
DOI
10.1002/clc.22707
language
English
LU publication?
yes
id
fabfc58e-acf2-4090-849d-32e01ac2b92f
date added to LUP
2017-05-15 16:36:11
date last changed
2017-09-20 12:47:12
@article{fabfc58e-acf2-4090-849d-32e01ac2b92f,
  abstract     = {<p>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 &lt; 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.</p>},
  author       = {Cortez, Daniel and Barham, Waseem and Ruckdeschel, Emily and Sharma, Nandita and McCanta, Anthony C. and von Alvensleben, Johannes and Sauer, William H. and Collins, Kathryn K. and Kay, Joseph and Patel, Sonali and Nguyen, Duy T.},
  issn         = {0160-9289},
  keyword      = {Atrial Flutter,Intra-atrial Re-entrant Tachycardia,Tetralogy of Fallot,Vectorcardiography},
  language     = {eng},
  number       = {8},
  pages        = {591--596},
  publisher    = {Wiley-Blackwell},
  series       = {Clinical Cardiology},
  title        = {Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement},
  url          = {http://dx.doi.org/10.1002/clc.22707},
  volume       = {40},
  year         = {2017},
}