DOI QR코드

DOI QR Code

Electrocardiography Recordings in Higher Intercostal Space for Children With Right Ventricular Outlet Obstruction Reconstruction Operation

  • Kim, Jung-Ok (Department of Pediatrics, Inje University Busan Paik Hospital) ;
  • Kim, Yeo-Hyang (Department of Pediatircs, Keimyung University School of Medicine) ;
  • Hyun, Myung-Chul (Department of Pediatrics, Kyungpook National University School of Medicine)
  • Published : 2012.06.30

Abstract

Background and Objectives: We checked traditional and high-level precordial electrocardiogram (ECG) leads in patients who had undergone right ventricular outlet obstruction (RVOT) reconstruction surgery and evaluated the effect of ECG lead position on their QRS duration. Subjects and Methods: We enrolled 34 patients who had undergone surgery for congenital heart disease with RVOT obstruction and who had received followed up care that included recorded ECG at a pediatric cardiac out-patient clinic. The control group included 29 patients who did not have hemodynamically significant intracardiac abnormality. We recorded traditional standard 12-leads ECG from the 4th intercostals space, and moved the precordial leads to the 3rd and 2nd intercostals spaces, and recorded ECGs repeatedly. Results: In all groups, there was no significant difference of mean QRS duration and QTc interval between traditional standard 12-leads ECGs and ECGs at higher intercostals spaces. There was no significant difference of ECG parameters between groups. In the control group, the degree of the change between the 4th intercostals space (ICS) QRS and 3rd ICS QRS was significant (p=0.031), and although, it was insignificant, ECGs at the 3rd ICS showed decreased QRS duration in group 1 (V1: 3rd ICS 119.21${\pm}$21.53 msec vs. 4th ICS 122.80${\pm}$31.78 msec. V2: 3rd ICS 113.68${\pm}$19.43 msec vs. 4th ICS 118.24${\pm}$19.16 msec). Conclusion: Although the positional change of ECG leads did not result in a significant effect on measuring QRS duration after surgery, ECG leads at the 3rd ICS rather than at the 4th ICS may cause alteration of ECG readings. Therefore, we suggest that ECGs should be recorded in as accurate a position as possible.

Keywords

References

  1. Harrison DA, Harris L, Siu SC, et al. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol 1997;30:1368-73. https://doi.org/10.1016/S0735-1097(97)00316-1
  2. Kugler JD. Predicting sudden death in patients who have undergone tetralogy of fallot repair: is it really as simple as measuring ECG intervals? J Cardiovasc Electrophysiol 1998;9:103-6. https://doi.org/10.1111/j.1540-8167.1998.tb00873.x
  3. Marie PY, Marçon F, Brunotte F, et al. Right ventricular overload and induced sustained ventricular tachycardia in operatively "repaired" tetralogy of Fallot. Am J Cardiol 1992;69:785-9. https://doi.org/10.1016/0002-9149(92)90506-T
  4. Garson A Jr, Porter CB, Gillette PC, McNamara DG. Induction of ventricular tachycardia during electrophysiologic study after repair of tetralogy of Fallot. J Am Coll Cardiol 1983;1:1493-502. https://doi.org/10.1016/S0735-1097(83)80054-0
  5. Balaji S, Lau YR, Case CL, Gillette PC. QRS prolongation is associated with inducible ventricular tachycardia after repair of tetralogy of Fallot. Am J Cardiol 1997;80:160-3. https://doi.org/10.1016/S0002-9149(97)00311-1
  6. Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000;356:975-81. https://doi.org/10.1016/S0140-6736(00)02714-8
  7. Lucron H, Marcon F, Bosser G, Lethor JP, Marie PY, Brembilla-Perrot B. Induction of sustained ventricular tachycardia after surgical repair of tetralogy of Fallot. Am J Cardiol 1999;83:1369-73. https://doi.org/10.1016/S0002-9149(99)00102-2
  8. Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart 2000; 84:416-20. https://doi.org/10.1136/heart.84.4.416
  9. Wu MH. Sudden death in pediatric populations. Korean Circ J 2010;40: 253-7. https://doi.org/10.4070/kcj.2010.40.6.253
  10. Lee YS, Baek JS, Kwon BS, et al. Pediatric emergency room presentation of congenital heart disease. Korean Circ J 2010;40:36-41. https://doi.org/10.4070/kcj.2010.40.1.36
  11. Rudiger A, Hellermann JP, Mukherjee R, Follath F, Turina J. Electrocardiographic artifacts due to electrode misplacement and their frequency in different clinical settings. Am J Emerg Med 2007;25:174-8. https://doi.org/10.1016/j.ajem.2006.06.018
  12. Batchvarov VN, Malik M, Camm AJ. Incorrect electrode cable connection during electrocardiographic recording. Europace 2007;9:1081-90. https://doi.org/10.1093/europace/eum198
  13. Babu-Narayan SV, Kilner PJ, Li W, et al. Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of fallot and its relationship to adverse markers of clinical outcome. Circulation 2006;113:405-13. https://doi.org/10.1161/CIRCULATIONAHA.105.548727
  14. Anter E, Frankel DS, Marchlinski FE, Dixit S. Effect of electrocardiographic lead placement on localization of outflow tract tachycardias. Heart Rhythm 2012;9:697-703. https://doi.org/10.1016/j.hrthm.2011.12.007
  15. Sangwatanaroj S, Prechawat S, Sunsaneewitayakul B, Sitthisook S, Tosukhowong P, Tungsanga K. New electrocardiographic leads and the procainamide test for the detection of the Brugada sign in sudden unexplained death syndrome survivors and their relatives. Eur Heart J 2001; 22:2290-6. https://doi.org/10.1053/euhj.2001.2691
  16. Sangwatanaroj S, Prechawat S, Sunsaneewitayakul B, Sitthisook S, Tosukhowong P, Tungsanga K. Right ventricular electrocardiographic leads for detection of Brugada syndrome in sudden unexplained death syndrome survivors and their relatives. Clin Cardiol 2001;24:776-81. https://doi.org/10.1002/clc.4960241205
  17. Shimizu W, Matsuo K, Takagi M, et al. Body surface distribution and response to drugs of ST segment elevation in Brugada syndrome: clinical implication of eighty-seven-lead body surface potential mapping and its application to twelve-lead electrocardiograms. J Cardiovasc Electrophysiol 2000;11:396-404. https://doi.org/10.1111/j.1540-8167.2000.tb00334.x
  18. Nanke T, Nakazawa K, Arai M, et al. Clinical significance of the dispersion of the activation--recovery interval and recovery time as markers for ventricular fibrillation susceptibility in patients with Brugada syndrome. Circ J 2002;66:549-52. https://doi.org/10.1253/circj.66.549
  19. Takagi A, Nakazawa K, Sakurai T, Nanke T, Miyake F. Prolongation of LAS40 (duration of the low amplitude electric potential component (<40 microV) of the terminal portion of the QRS) induced by isoproterenol in 11 patients with Brugada syndrome. Circ J 2002;66:1101-4. https://doi.org/10.1253/circj.66.1101
  20. Oreto G, Corrado D, Delise P, et al. Doubts of the cardiologist regarding an electrocardiogram presenting QRS V1-V2 complexes with positive terminal wave and ST segment elevation. Consensus conference promoted by the Italian Cardiology Society. G Ital Cardiol (Rome) 2010;11(11 Suppl 2):3S-22.