Electrocardiographic correlates of ventricular arrhythmias in repaired congenital heart disease

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-01-01 DOI:10.1016/j.hroo.2024.10.006

Satoshi Kawada MD, PhD , Hiroshi Morita MD, PhD , Koji Nakagawa MD, PhD , Tomofumi Mizuno MD , Takuro Masuda MD , Akira Ueoka MD, PhD , Saori Asada MD, PhD , Masakazu Miyamoto MD, PhD , Norihisa Toh MD, PhD , Nobuhiro Nishii MD, PhD , Shingo Kasahara MD, PhD , Shinsuke Yuasa MD, PhD

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Abstract

Background

Sudden cardiac death (SCD) is a major cause of mortality in congenital heart disease (CHD). Ventricular arrhythmias (VAs) are responsible for 80% of SCD. However, the clinical characteristics of patients with CHD and VAs are not fully understood.

Objective

This study was undertaken to evaluate clinical and electrocardiographic characteristics of patients with CHD based on the presence or absence of VAs.

Methods

We identified 28 patients with CHD with VAs (men, n = 15; 35.9 ± 16.5 years). Two patients with channelopathies were excluded from the analysis.

Results

The most common diagnoses in patients with VAs were a transposition of the great arteries (n = 8, 30.8%), followed by tetralogy of Fallot (n = 7, 26.9%). Compared with patients without VA (n = 43), those with VAs had a longer QRS (160.6 ± 52.9 ms vs 133.4 ± 29.3 ms; P = .004), a higher prevalence of fragmented QRS (65.4% vs 37.2%; P = .022) and more epsilon wave (23.1% vs 2.3%; P = .005). Multivariable analysis showed that QRS > 180 ms (odds ratio [OR], 22.23; 95% confidence interval [CI], 2.40–206.53) and epsilon wave (OR, 14.33; 95% CI, 1.47–139.58) were significantly associated with VAs. During a median follow-up duration of 5.4 years, 5 patients (19.2%) received appropriate ICD therapy, and 3 patients (11.5%) died of heart failure.

Conclusion

The assessment of QRS duration and the presence of fQRS and epsilon waves in patients with CHD could improve risk prediction for the development of VAs. These electrocardiogram (ECG) features could assist in clinical decision-making and might consequently reduce mortality.

Abstract Image

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背景心脏性猝死（SCD）是先天性心脏病（CHD）的主要致死原因。室性心律失常（VAs）是造成 80% SCD 的原因。本研究旨在根据是否存在室性心律失常评估 CHD 患者的临床和心电图特征。结果VA患者最常见的诊断是大动脉转位（8例，30.8%），其次是法洛四联症（7例，26.9%）。与无 VA 患者（n = 43）相比，有 VA 的患者 QRS 更长（160.6 ± 52.9 ms vs 133.4 ± 29.3 ms；P = .004），QRS 片断的发生率更高（65.4% vs 37.2%；P = .022），ε波更多（23.1% vs 2.3%；P = .005）。多变量分析显示，QRS > 180 ms（几率比 [OR]，22.23；95% 置信区间 [CI]，2.40-206.53）和ε波（OR，14.33；95% CI，1.47-139.58）与 VAs 显著相关。中位随访时间为 5.4 年，5 名患者（19.2%）接受了适当的 ICD 治疗，3 名患者（11.5%）死于心力衰竭。这些心电图（ECG）特征有助于临床决策，从而降低死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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