Browse > Article
http://dx.doi.org/10.3345/kjp.2009.52.12.1364

The changes in signal-averaged electrocardiogram after surgical correction of congenital heart disease  

Kim, Yeo Hyang (Department of Pediatrics, Keimyung University School of Medicine)
Choe, Hee Jung (Department of Pediatrics, Gumi CHA General Hospital)
Kim, Gun Jik (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University School of Medicine)
Cho, Joon Yong (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University School of Medicine)
Hyun, Myung Chul (Department of Pediatrics, Kyungpook National University School of Medicine)
Lee, Sang Bum (Department of Pediatrics, Kyungpook National University School of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.52, no.12, 2009 , pp. 1364-1369 More about this Journal
Abstract
Purpose : To analyze abnormal ventricular activation in childhood congenital heart disease induced by postoperative changes in ventricular volume and pressure and ventricular scar formation using signal-averaged electrocardiography (SAECG). Methods : Fifty-two patients who had undergone open heart surgery (OHS) were enrolled. Patients were divided into the following 3 groups: right ventricular volume overload (atrial septal defect, group1), left ventricular volume overload (ventricular septal defect, group2), and right ventricular pressure overload (tetralogy of Fallot, group 3). The patients were monitored by standard 12-lead ECG and SAECG before and 2 months after the operation. QRS duration, QT and QTc intervals, filtered QRS (f-QRS), high frequency low amplitude potential (HFLA), and root mean square (RMS) voltage in the terminal 40 ms of SAECG were determined. Results : In the preoperative period, group1 showed significant increase in QRS (P=0.011) compared to those of the other 2 groups. In the postoperative period, group3 showed significant increase in the QTc interval (P=0.004) compared to those in the other 2 groups. SAECG parameters showed no significant differences among the groups in the pre- or postoperative period. Of the 52 patients, 12 (23%) in the preoperative period and 21 (40%) in the postoperative period had at least 1 SAECG abnormality. The prevalence of SAECG abnormalities was significantly higher in the postoperative group 2 and group 3 (preoperative: 20% versus postoperative: 28%, P<0.001, preoperative: 14% versus postoperative: 64%, P<0.001, respectively). Conclusion : Abnormal SAECG patterns may be attributed to postoperative scars, OHS itself, and/or ventricular overload.
Keywords
Congenital heart disease; Signal-averaged electrocardiography; Open heart surgery;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Simson MB. Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation 1981;64:235-42   DOI   PUBMED   ScienceOn
2 Vaksmann G, Gutierrez R, Duhamel A, Nelken B, Francart C, Kouakam C, et al. Signal-averaged electrocardiography in children with anthracycline-induced cardiomyopathy. Pediatr Cardiol 2001;22:494-8   DOI   ScienceOn
3 Gomes JA, Winters SL, Stewart D, Targonski A, Barreca P. Optimal bandpass filters for time-domain analysis of the signal- averaged electrocardiogram. Am J Cardiol 1987;60:1290-8   DOI   ScienceOn
4 Hayabuchi Y, Matsuoka S, Kubo M, Akita H, Kuroda Y. Age- related criteria for signal-averaged electrocardiographic late potentials in children. Pediatr Cardiol 1994;15:107-11   DOI   PUBMED   ScienceOn
5 Davis AM, McCrindle BW, Hamilton RM, Moore-Coleman P, Gow RM. Normal values for the childhood signal-averaged ECG. Pacing Clin Electrophysiol 1996;19:793-801   DOI   ScienceOn
6 Vialle E, Albalkhi R, Zimmerman M, Friedli B. Normal values of signal-averaged electrocardiographic parameters and QT dispersion in infants and children. Cardiol Young 1999;9:556-61   DOI   PUBMED   ScienceOn
7 Rovamo L, Mäkijärvi M, Pesonen E, Wallgren EI, Toivonen L. Later potentials on signal-averaged electrocardiograms in children after right ventriculotomy. Pediatr Cardiol 1995;16:114-9   DOI   ScienceOn
8 Keeling PJ, Kulakowski P, Yi G, Slade AK, Bent SE, McKenna WJ. Usefulness of signal-averaged electrocardiogram in idiopathic dilated cardiomyopathy for identifying patients with ventricular arrhythmias. Am J Cardiol 1993;72:78-84   DOI   ScienceOn
9 Giroud D, Zimmermann M, Adamec R, Oberhänsli I, Friedli B. Ventricular late potentials and spontaneous ventricular arrhythmias after surgical repair of tetralogy of Fallot: do they have prognostic value? Br Heart J 1994;72:580-3   DOI   ScienceOn
10 Stelling JA, Danford DA, Kugler JD, Windle JR, Cheatham JP, Gumbiner CH, et al. Late potentials and inducible ventricular tachycardia in surgically repaired congenital heart disease. Circulation 1990;82:1690-6   DOI   PUBMED   ScienceOn
11 Janousek J, Paul T, Bartakova H. Role of late potentials in identifying patients at risk for ventricular tachycardia after surgical correction of congenital heart disease. Am J Cardiol 1995;75: 146-50   DOI   ScienceOn
12 Perloff JK, Middlekauf HR, Child JS, Stevenson WG, Miner PD,Goldberg GD. Usefulness of post-ventriculotomy signal averaged electrocardiograms in congenital heart disease. Am J Cardiol 2006;98:1646-51   DOI   ScienceOn
13 Asimakopoulos G. Mechanisms of the systemic inflammatory response. Perfusion 1999;14:269-77   DOI   ScienceOn
14 Balkhi RA, Beghetti M, Friedli B. Time course of appearance of markers of arrhythmia in patients with tetralogy of Fallot before and after surgery. Cardiol Young 2004;14:360-6   DOI   ScienceOn
15 Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 2000;69:1198-204   DOI   ScienceOn
16 el-Sherif N. Electrophysiologic basis of ventricular late potentials. Prog Cardiovasc Dis 1993;35:417-27   DOI   PUBMED   ScienceOn
17 Buxton AE, Simson MB, Falcone RA, Marchlinski FE, Doherty JU, Josephson ME. Results of signal-averaged electrocardiography and electrophysiologic study in patients with nonsustained ventricular tachycardia after healing of acute myocardial infarction. Am J Cardiol 1987;60:80-5
18 Breithardt G, Cain ME, el-Sherif N, Flowers NC, Hombach V, Janse M, et al. Standards for analysis of ventricular late potentials using high-resolution or signal-averaged electrocardiography: a statement by a task force committee of the European Society of Cardiology, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol 1991;17:999-1006   DOI   PUBMED
19 Fallah-Najmabadi H, Dahdah NS, Palcko M, Mehta SK. Normal values and methodologic recommendations for signal-averaged electrocardiography in children and adolescents. Am J Cardiol 1996;77:408-12   DOI   ScienceOn
20 Lander P, Berbari EJ. Principles and signal processing techniques of the high-resolution electrocardiogram. Pro Cardiovasc Dis 1992;35:169-88   DOI   ScienceOn