Sinus rhythm QRS morphology reflects right ventricular activation and anatomical ventricular tachycardia isthmus conduction in repaired tetralogy of Fallot
Authors' conclusion
For patients with repaired TOF, the status of septal isthmus conduction was evident from sinus rhythm QRS morphology. Low-amplitude, fragmented R' waves in lead V1 and terminal S waves in the inferior leads were related to septal isthmus conduction abnormalities, providing a mechanistic link between RV activation and common electrocardiographic findings.
Study context
- Population
- Patients with repaired tetralogy of Fallot (TOF) and complete right bundle branch block referred for transcatheter pulmonary valve replacement (PVR) or presenting with sustained ventricular tachycardia (VT)19 pre-PVR, 3 clinical VT
- Participants
- 22 patients
- Comparison
- Septal isthmus block vs intact isthmus conduction
- Outcome
- Sinus rhythm QRS morphology vs RV activation and anatomical isthmus conduction
Methodological detailsComprehensive 3-dimensional mapping in sinus rhythm
- Comprehensive 3-dimensional mapping in sinus rhythm
Main finding
As reported in the abstract
| Group | R' amplitude in V1 | QRS fragmentation in V1 | Terminal S waves in aVF |
|---|---|---|---|
| Isthmus block | 5.8 mV | 15 [94%] | 15 [94%] |
| Intact conduction | 9.4 mV | 2 [13%] | 6 [40%] |
R' amplitude in V1
Isthmus block5.8 mV
Intact conduction9.4 mV
QRS fragmentation in V1
Isthmus block15 [94%]
Intact conduction2 [13%]
Terminal S waves in aVF
Isthmus block15 [94%]
Intact conduction6 [40%]
- Isthmus block vs Intact conduction: P = 0.005 — lower-amplitude R' in V1
- Isthmus block vs Intact conduction: P < 0.001 — QRS fragmentation in V1
- Isthmus block vs Intact conduction: P < 0.001 — terminal S waves in aVF
Original publication
Sinus rhythm QRS morphology reflects right ventricular activation and anatomical ventricular tachycardia isthmus conduction in repaired tetralogy of Fallot. Heart Rhythm. Published 19 August 2023. doi:10.
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