Advertisement

Usefulness of Prolonged PR Interval to Predict Atrial Tachyarrhythmia Development Following Surgical Repair of Tetralogy of Fallot

Published:September 17, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.08.029
      Atrial tachyarrhythmias (ATAs), which may occur after tetralogy of Fallot (TOF) surgery, can cause sudden cardiac death. However, ATAs may also develop in response to electrical substrates. This study aims to examine the predictive factors for ATAs by identifying electrical substrates in the atrium obtained from 12-lead electrocardiogram in patients who underwent TOF repair. A total of 144 patients aged >15 years (median, 31.6 years) who underwent TOF repair at Hokkaido University were enrolled. We investigated the correlation between the development of ATAs with age, time interval after initial corrective surgery, brain natriuretic peptide levels, cardiac magnetic resonance parameters (right ventricular end-diastolic volume index, right ventricular end-systolic volume index, right ventricular ejection fraction, right atrial volume index, left ventricular end-diastolic volume index, left ventricular ejection fraction), and 12-lead electrocardiogram parameters (P wave maximum voltage, PR interval, QRS width, number of fragmented QRS). Of the 144 patients, 44 patients (30.6%) developed ATAs. Multivariate analysis revealed time interval after initial corrective surgery (odds ratio 6.7, 95% confidence interval 1.78 to 12.6) and PR interval (odds ratio 2.7, 95% confidence interval: 1.17 to 4.20) as independent risk factors for the development of ATAs. The receiver operating characteristic curve revealed a PR interval cut-off value of >200 milliseconds as predictive of the development of ATAs in patients more than 15 years after initial corrective surgery (area under the curve, 0.658; sensitivity, 71.4%; specificity, 66.4%). The present study demonstrated that a prolonged PR interval is a simple and convenient predictor for the development of ATAs in patients who underwent TOF repair.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Khairy P
        • Aboulhosn J
        • Gurvitz MZ
        • Opotowsky AR
        • Mongeon FP
        • Kay J
        • Valente AM
        • Earing MG
        • Lui G
        • Gersony DR
        • Cook S
        • Ting JG
        • Nickolaus MJ
        • Webb G
        • Landzberg MJ
        • Broberg CS
        Alliance for Adult Research in Congenital Cardiology (AARCC). Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study.
        Circulation. 2010; 122: 868-875
        • Kido T
        • Ueno T
        • Taira M
        • Kanaya T
        • Okuda N
        • Toda K
        • Kuratani T
        • Sawa Y.
        Clinical significance of right atrial volume in patients with repaired tetralogy of Fallot.
        Interact Cardiovasc Thorac Surg. 2020; 30: 296-302
        • Hanneman K
        • Crean AM
        • Wintersperger BJ
        • Thavendiranathan P
        • Nguyen ET
        • Kayedpour C
        • Wald RM.
        The relationship between cardiovascular magnetic resonance imaging measurement of extracellular volume fraction and clinical outcomes in adults with repaired tetralogy of Fallot.
        Eur Heart J Cardiovasc Imaging. 2018; 19: 777-784
        • Shiina Y
        • Taniguchi K
        • Nagao M
        • Takahashi T
        • Niwa K
        • Kawakubo M
        • Inai K.
        The relationship between extracellular volume fraction in symptomatic adults with tetralogy of Fallot and adverse cardiac events.
        J Cardiol. 2020; 75: 424-431
        • Rheinheimer S
        • Reh C
        • Figiel J
        • Mahnken AH.
        Assessment of right atrium volume by conventional CT or MR techniques: which modality resembles in vivo reality?.
        Eur J Radiol. 2016; 85: 1040-1044
        • Zomer AC
        • Uiterwaal CS
        • van der Velde ET
        • Tijssen JG
        • Mariman EC
        • Verheugt CL
        • Vaartjes I
        • Pieper PG
        • Meijboom FJ
        • Grobbee DE
        • Mulder BJ.
        Mortality in adult congenital heart disease: are national registries reliable for cause of death?.
        Int J Cardiol. 2011; 152: 212-217
        • Kaemmerer H
        • Fratz S
        • Bauer U
        • Oechslin E
        • Brodherr-Heberlein S
        • Zrenner B
        • Turina J
        • Jenni R
        • Lange PE
        • Hess J
        Emergency hospital admissions and three-year survival of adults with and without cardiovascular surgery for congenital cardiac disease.
        J Thorac Cardiovasc Surg. 2003; 126: 1048-1052
        • Gatzoulis MA
        • Balaji S
        • Webber SA
        • Siu SC
        • Hokanson JS
        • Poile C
        • Rosenthal M
        • Nakazawa M
        • Moller JH
        • Gillette PC
        • Webb GD
        • Redington AN.
        Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study.
        Lancet. 2000; 356: 975-981
        • Harrison DA
        • Siu SC
        • Hussain F
        • MacLoghlin CJ
        • Webb GD
        • Harris L.
        Sustained atrial arrhythmias in adults late after repair of tetralogy of Fallot.
        Am J Cardiol. 2001; 87: 584-588
        • Cheng S
        • Keyes MJ
        • Larson MG
        • McCabe EL
        • Newton-Cheh C
        • Levy D
        • Benjamin EJ
        • Vasan RS
        • Wang TJ.
        Long-term outcomes in individuals with a prolonged PR interval or first-degree atrioventricular block.
        JAMA. 2009; 301: 2571-2577
        • Khairy P
        • Van Hare GF
        • Balaji S
        • Berul CI
        • Cecchin F
        • Cohen MI
        • Daniels CJ
        • Deal BJ
        • Dearani JA
        • Nd Groot
        • Dubin AM
        • Harris L
        • Janousek J
        • Kanter RJ
        • Karpawich PP
        • Perry JC
        • Seslar SP
        • Shah MJ
        • Silka MJ
        • Triedman JK
        • Walsh EP
        • Warnes CA.
        PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD).
        Heart Rhythm. 2014; 11: e102-e165
        • Kimura Y
        • Fukuda K
        • Nakano M
        • Hasebe Y
        • Fukasawa K
        • Chiba T
        • Miki K
        • Tatebe S
        • Miyata S
        • Ota H
        • Kimura M
        • Adachi O
        • Saiki Y
        • Shimokawa H.
        Prognostic significance of PR interval prolongation in adult patients with total correction of tetralogy of Fallot.
        Circ Arrhythm Electrophysiol. 2018; 11e006234
        • Zhao Z
        • Wang Y
        • Chen Y
        • Wang X
        • Li J
        • Yuan M
        • Liu T
        • Li G.
        Cilostazol prevents atrial structural remodeling through the MEK/ERK pathway in a canine model of atrial tachycardia.
        Cardiology. 2016; 135: 240-248
        • Zhao J
        • Liu T
        • Liu E
        • Li G
        • Qi L
        • Li J.
        The potential role of atrial natriuretic peptide in the effects of angiotensin-(1–7) in a chronic atrial tachycardia canine model.
        J Renin Angiotensin Aldosterone Syst. 2016; 171470320315627409
        • Lee MA
        • Weachter R
        • Pollak S
        • Kremers MS
        • Naik AM
        • Silverman R
        • Tuzi J
        • Wang W
        • Johnson LJ
        • Euler DE
        • ATTEST Investigators
        The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: results of a randomized trial in patients with bradycardia and atrialtachyarrhythmias.
        J Am Coll Cardiol. 2003; 41: 1926-1932
        • Israel CW
        • Hügl B
        • Unterberg C
        • Lawo T
        • Kennis I
        • Hettrick D
        • Hohnloser SH
        AT500 Verification Study Investigators. Pace-termination and pacing for prevention of atrial tachyarrhythmias: results from a multicenter study with an implantable device for atrial therapy.
        J Cardiovasc Electrophysiol. 2001; 12: 1121-1128
        • Crossley GH
        • Padeletti L
        • Zweibel S
        • Hudnall JH
        • Zhang Y
        • Boriani G.
        Reactive atrial-based antitachycardia pacing therapy reduces atrialtachyarrhythmias.
        Pacing Clin Electrophysiol. 2019; 42: 970-979
        • Gonzalez Corcia MC
        • Walsh EP
        • Emani S.
        Long-term results of atrial maze surgery in patients with congenital heart disease.
        Europace. 2019; 21: 1345-1352