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Korrelation von Volumen des rechten Vorhofs mit dem Auftreten von supraventrikulären und ventrikulären Arrhythmien bei Patienten mit korrigerter Fallot-Tetralogie

Right Atrial Volume is increased in corrected Tetralogy of Fallot and correlates with the incidence of Supraventricular Arrhythmia

Christina Rosenberg
Doctoral thesis
Date of Examination: 2016-11-29
Date of issue: 2016-11-18
Advisor: Lotz, Joachim Prof. Dr.
Referee: Sigler, Matthias Prof. Dr.
Referee: Oppermann, Martin Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-002B-7CAF-C

 

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Abstract

English

The aim of this study was to evaluate right atrial (RA) volume in corrected Tetralogy of Fallot (cTOF) and assess its correlation with the occurrence of supraventricular (SV) arrhythmia. Cardiac magnetic reso- nance imaging (CMR) and 24-h Holter were performed in n = 67 consecutive cTOF patients (age 30 ± 11.3 years). The CMR protocol included standard HASTE, SSFP cine, and blood flow measurements. Correlations between ar- rhythmia in ECG, heart volume, and functional parameters were investigated by negative binominal regression. Pa- tients’ characteristics (mean ± SD) included mean RA volume of 49 ± 19 ml/m2 (HASTE sequence), mean right ventricular (RV) end-diastolic volume of 98 ± 27 ml/m2, mean pulmonary valve regurgitation fraction (PR) of 21 ± 19 %, BMI of 25 kg/m2, and heart rate of 75/min. Twenty-eight out of 67 patients experienced SV arrhythmia including SV couplets or bigeminus or longer non-sus- tained SV tachycardia (SVT) episodes. RA volume index was identified as an independent risk factor for different degrees of SV arrhythmia (SV couplets/bigeminus p <0.001, SVT p <0.001). Further risk factors for SV arrhythmia were male gender (p = 0.023) and decreased left ventricular (LV) ejection fraction (EF) (LV EF p < 0.001). RA volume is increased in adult patients with cTOF with larger RA volumes relating to higher incidence of SV arrhythmia. SV arrhythmia also appeared more often in male patients and those with decreased LV EF. Risk stratification according to these parameters could help to optimize early prevention and adjusted individual therapy to improve patient outcome and quality of life.
Keywords: Tetralogy of Fallot; Arrhythmia; congenital heart failure; Pediatric cardiology; MRI; follow up
Schlagwörter: Fallot-Tetralogie; Arrhythmien; angeborener Herzfehler; MRT; Kinderkardiologie; Pädiatrie
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