The pathophysiologic aspects and clinical implications of electrocardiographic parameters of ventricular conduction delay in repaired tetralogy of Fallot

• Published in: Journal of electrocardiology Vol. 47; no. 5; pp. 618 - 624
• Main Authors: Udink ten Cate, Floris E.A., Sreeram, Narayanswami, Brockmeier, Konrad
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2014
• Subjects: Arrhythmias, Cardiac - physiopathology; Brugada Syndrome; Cardiac Catheterization; Cardiac Conduction System Disease; Cardiovascular; Electrocardiography; Heart Conduction System - abnormalities; Heart Conduction System - physiopathology; Heart Ventricles - physiopathology; Humans; Myocardial fibrosis; QRS duration; QRS fragmentation; Sudden cardiac death; Tetralogy of Fallot; Tetralogy of Fallot - diagnostic imaging; Tetralogy of Fallot - physiopathology; Tetralogy of Fallot - surgery; Ultrasonography; Ventricular arrhythmia; Tetralogy of Fallot; Ventricular arrhythmia; Myocardial fibrosis; QRS duration; Sudden cardiac death; QRS fragmentation
• ISSN: 0022-0736; 1532-8430; 1532-8430
• DOI: 10.1016/j.jelectrocard.2014.07.005

The 12-lead surface electrocardiogram is a valuable and feasible clinical tool in the management of patients following tetralogy of Fallot (TOF) repair. The importance of QRS duration in TOF patients has long been acknowledged. A prolonged QRS complex has been associated with increased risk for subsequent life-threatening ventricular arrhythmia and sudden cardiac death. Our current ability to risk-stratify TOF patients for malignant arrhythmogenic events primarily on the basis of QRS duration is rather limited. Nevertheless, increasing evidence suggests that QRS morphology and duration may be useful as surrogate markers of infundibular and regional right ventricular myocardial disease. The aim of this review is to provide a critical appraisal of the clinical implications of established and new electrocardiographic markers of ventricular conduction delay in TOF patients following surgical correction with a particular focus on QRS duration, lengthening, and fragmentation. In addition, the pathophysiological background of these parameters is addressed.