Korean Circ J.  2013 Dec;43(12):825-829. 10.4070/kcj.2013.43.12.825.

QTc Prolongation after Ventricular Septal Defect Repair in Infants

• Han CW
• Woo SB
• Choi JY
• Jung JW
• Park YH
• Park HK
• Shin HJ
• Kim NK

• KMID: 2224777
• DOI: http://doi.org/10.4070/kcj.2013.43.12.825

Abstract

BACKGROUND AND OBJECTIVES
Prolonging of the corrected QT interval (QTc) has been reported after cardiac surgery in some studies. However, there have not been many studies on infant open cardiac surgery for ventricular septal defect (VSD) repair. This study was performed to define the changes in QTc and to find related post-surgery factors in this patient group.
SUBJECTS AND METHODS
From 2008 to 2012, 154 infants underwent VSD repair at the Severance Cardiovascular Hospital. This study includes 105 of these cases. QTc was measured in these patients retrospectively. Demographic data and peri-procedural data, such as Aristotle score, cross-clamp time and bypass time, were analyzed. The exclusion criteria included multiple and small VSDs that underwent direct closure.
RESULTS
Mean post-operative QTc was increased compared to the pre-operative measurements (from 413.6+/-2.3 to 444.9+/-2.5, p<0.001). In multiple linear regression, the comprehensive Aristotle score was associated with increasing QTc (p=0.047). The incidence of transient arrhythmia, such as atrial tachycardia, junctional ectopic tachycardia, premature atrial contraction, or premature ventricular contraction, was associated with QTc prolongation (p=0.005). Prolonged QTc was also associated with cross-clamp time (p=0.008) and low weight (p=0.042). Total length of stay at the intensive care unit and intubation time after surgery were not associated with QTc prolongation.
CONCLUSION
Prolonged QTc could be seen after VSD repair in infants. This phenomenon was associated with peri-procedural factors such as the Aristotle score and cross-clamp time. Patients with QTc prolongation after cardiac surgery had an increased tendency towards arrhythmogenicity in the post-operative period.

Keyword

Ventricular septal defect; Electrocardiography; Infant

MeSH Terms

Arrhythmias, Cardiac
Atrial Premature Complexes
Electrocardiography
Heart Septal Defects, Ventricular*
Humans
Incidence
Infant*
Intensive Care Units
Intubation
Length of Stay
Linear Models
Retrospective Studies
Tachycardia
Tachycardia, Ectopic Junctional
Thoracic Surgery
Ventricular Premature Complexes

Figure

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  Fig. 1 Post-operation electrocardiogram and QTc prolongation (QTc 516 ms). HR 149, RR interval 472 ms, PR interval 98, QRS duration 58 ms, QT interval 326 ms.

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  Fig. 2 Change in QTc over time. The average pre-operative QTc was 413.6±2.3 milliseconds (ms). The average post-operative QTc was 444.9±3.5 ms, 31.3±5.8 ms longer than the average pre-operative QTc (p<0.001). In the ECG performed one month after the surgery, the average QTc was 433.0±3.6 ms, which showed a reduction (-11.9±7.1 ms) compared to the immediate post-operative ECG (p=0.007). In the ECG performed one year after surgery, however, the average QTc was 436.4±30.2 ms, which did not show a significant change compared to the average QTc one month after the surgery (p=0.273). n=105. ECG: electrocardiogram.

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