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Depolarization, Repolarization Inhomogeneity and Late Potential after Surgical Repair of Tetralogy of Fallot

Journal of the Korean Pediatric Society 1999;42(8):1071-1077.
Published online August 15, 1999.
Depolarization, Repolarization Inhomogeneity and Late Potential after Surgical Repair of Tetralogy of Fallot
Soo Young Kim1, Myung Chul Hyun1, Sang Bum Lee1, Seung Tae Kim2, Jong Soo Lee3
1Department of Pediatrics, College of Medicine, Kyung-pook National University, Korea
2Department of Pediatrics, Fatima Hospital, Taegu, Korea
3Department of Pediatrics†, Handong University, Sunlin Hospital, Pohang, Korea
활로 4징의 교정수술 환아에서 탈분극과 재분극의 불균형과 후전위
김수영1, 현명철1, 이상범1, 김승태2, 이종수3
1경북대학교 의과대학 소아과학교실
2대구파티마병원 소아과
3한동대학교 선린병원 소아과
Correspondence: 
Soo Young Kim, Email: 1
Abstract
Purpose
: After repair of tetralogy of Fallot(TOF), ventricular arrhythmia and sudden death remain as serious late complications which are due to right ventricular systolic and diastolic overloading, exposure to hypoxia and surgical scar. Among the various methods for predicting the risk of such complications, we evaluated signal average ECG(SAECG), QRS duration, QT and JT dispersion, cardiothoracic(CT) ratio, age at repair and follow-up duration.
Methods
: Patients were divided into 3 groups : repaired TOF patients(group 1, n=22), patients with complete right bundle branch block(CRBBB) after ventricular septal defect and/or atrial septal defect repair(group 2, n=16) and normal controls(group 3, n=13). There were no significant differences in mean age at presentation, mean age at repair, or at mean follow up among the 3 groups.
Results
: QRS duration was significantly prolonged in group 1 and 2(121¡¾29ms, 119¡¾17ms, respectively) compared to group 3(81¡¾4ms)(P<0.01). In group 1, QRS duration showed significant positive correlations with age at repair(r=0.43, P<0.05) and follow-up duration(r=0.46, P<0.05). QT dispersion was significantly increased in group 1 and 2(88¡¾38ms, 71¡¾27ms, respectively) compared to group 3(37¡¾20ms)(P<0.01). JT dispersion showed significant differences among groups, being 96¡¾38ms in group 1, 68¡¾25ms in group 2, 44¡¾18ms in group 3(group 1 vs 2 : P<0.05, group 2 vs 3 : P<0.05, group 1 vs 3 : P<0.01). CT ratio was significantly increased in group 1(59¡¾6%) compared to group 2 and 3(50¡¾3%, 50¡¾2%, respectively)(P<0.01). There were no significant differences in parameters of SAECG among the 3 groups.
Conclusion
: We concluded that abnormality of JT dispersion, in repaired TOF pateints indicating inhomogeneity of repolarization, can be a cause of ventricular arrhythmia.
Key Words: Tetralogy of Fallot, Ventricular arrhythmia and sudden death, Signal average ECG, JT dispersion


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