Clinical InvestigationVentricular Dyssynchrony in ChildrenQRS Duration and Mechanical Dyssynchrony Correlations with Right Ventricular Function after Fontan Procedure
Section snippets
Methods
The institutional review board approved this cross-sectional, retrospective study. All patients with HLHS who had undergone the Fontan procedure were included. Patients also needed to have adequate echocardiographic images with frame rates of 60 to 110 frames/sec performed obtained using a Vivid I or Vivid 7 machine (GE Healthcare, Wauwatosa, WI). An electrocardiogram obtained within 3 months of the echocardiogram was also required. The offline echocardiographic database was searched for these
Results
A total of 30 patients with HLHS were identified, with 35 studies performed. Four studies were excluded, one because of an atrial arrhythmia, one because of the lack of an electrocardiographic tracing at the time of imaging, and two because of inadequate imaging and/or speckle-tracking analysis. A total of 31 studies from 26 patients were thus available for analysis.
The median age of the patients at the time of echocardiography was 5.3 years (range, 2.5–15.4 years), the median time from Fontan
Discussion
Increased electrical dyssynchrony measured by QRS duration and mechanical dyssynchrony measured via various echocardiographic techniques have been shown in the adult population to correlate with worse left ventricular and RV function.8, 9, 23 In the pediatric population with biventricular physiology, narrowing of the QRS duration via CRT has been noted to correlate with improved function.10, 11, 12 Increased QRS duration and mechanical dyssynchrony have been reported in patients with single RV
Conclusions
Both QRS duration and mechanical dyssynchrony measurements were correlated with RV function in patients with single right ventricles, albeit weakly. The clinical significance of these findings is unknown, and only larger studies will determine if these measurements are beneficial or not in deciding treatment options for this complex patient population.
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