Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume

Aims: Late after total correction, Fallot patients with a long QRS duration are prone to serious arrhythmias and sudden cardiac death. Pulmonary regurgitation is a common cause of right ventricular (RV) failure and QRS lengthening. We studied the effects of pulmonary valve replacement (PVR) on QRS duration and RV volume. Methods and results: Twenty-six consecutive Fallot patients were evaluated both pre-operatively and 6-12 months post-operatively by cardiac magnetic resonance (CMR). In this study, we present the computer-assisted analysis of the standard 12-lead electrocardiograms closest in time to the CMR studies. For the whole group, QRS duration shortened by 6 ± 8 ms, from 151 ± 30 to 144 ± 29 ms (P = 0.002). QRS duration decreased in 18 of 26 patients by 10 ± 6 ms, from 152 ± 32 to 142 ± 31 ms. QRS duration remained constant or increased slightly in eight of 26 patients by 3 ± 3 ms, from 148 ± 27 to 151 ± 25 ms. CMR showed a decrease in RV end-diastolic volume from 305 ± 87 to 210 ± 62 ml. (P = 0.000004). QRS duration changes correlated with RV end-diastolic volume changes (r = 0.54, P = 0.01). Conclusion: Our study shows that PVR reduces QRS duration. The amount of QRS reduction is related to the success of the operation, as expressed by the reduction in RV end-diastolic volume.

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