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. 2000 Oct;84(4):409–415. doi: 10.1136/heart.84.4.409

Late arrhythmia in adults with the Mustard procedure for transposition of great arteries: a surrogate marker for right ventricular dysfunction?

M Gatzoulis 1, J Walters 1, P McLaughlin 1, N Merchant 1, G Webb 1, P Liu 1
PMCID: PMC1729461  PMID: 10995411

Abstract

OBJECTIVE—To examine the relation between ventricular dysfunction and late clinical arrhythmia in adults who underwent the Mustard procedure for transposition of the great arteries.
DESIGN—Observational study based on periodic outpatient assessment of biventricular function.
SETTING—Tertiary referral centre.
INTERVENTIONS—Analysis of data from 12 lead ECGs, echocardiography, exercise radionuclide ventriculography, and magnetic resonance imaging.
MAIN OUTCOME MEASURES—Clinical outcome and late onset clinical arrhythmia during follow up. ECG and ventricular function indices obtained before arrhythmia onset were used for analysis.
RESULTS—51 patients (mean (SD) age 25.7 (5.0) years) fulfilled entry criteria at a mean of 23.4 (4.0) years after the Mustard procedure. Late arrhythmia occurred in 11 (22%): sustained atrial flutter/fibrillation in 10, ventricular tachycardia in one. Compared with patients who remained arrhythmia free, patients with arrhythmia had longer QRS (129 (26) v 112 (16) ms, p = 0.01), greater QT dispersion (107 (28) v 51 (24) ms, p < 0.001), and increased ratio of right to left ventricular end diastolic diameter (2.4 (0.9) v 1.7 (0.7), p = 0.02), but no difference in wall thickness. Systemic ejection fraction was also reduced in the arrhythmia subgroup (at rest: 34.1 (13)% v 47 (16)%, p = 0.04; during exercise: 37.8 (12)% v 52 (17)%, p = 0.03). QRS duration correlated with right ventricular end diastolic diameter (r = 0.59, p < 0.001), suggesting a possible mechano-electric relation after the Mustard procedure. QT dispersion was the only predictor of clinical arrhythmia in multivariate analysis.
CONCLUSIONS—Impaired ventricular function in adults with the Mustard procedure for transposition of the great arteries relates to clinical arrhythmia. Late atrial flutter/fibrillation may be a surrogate marker for ventricular dysfunction, and these patients may also be at risk of ventricular tachycardia.


Keywords: congenital heart disease; transposition of great vessels; arrhythmia; radionuclide ventriculography

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Figure 1  .

Figure 1  

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(A) Maximum QRS duration and QT dispersion from surface ECG measured manually before the onset of arrhythmia and drug treatment. (B) Means of ratios of right to left ventricular end diastolic diameter and wall thickness on magnetic resonance imaging between the 11 patients with arrhythmia and the remaining 40 arrhythmia-free patients (transaxial views at mid-ventricular frames, average of two measurements). (C) Ejection fraction of the systemic right ventricle by exercise radionuclide ventriculography. MRI, magnetic resonance imaging; RNA, radionuclide ventriculography; RVEF, right ventricular ejection fraction; RV/LV EDD, right to left ventricular end diastolic diameter; RV/LV WT, right to left ventricular wall thickness (end diastole).

Figure 2  .

Figure 2  

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Linear correlation between maximum QRS duration (measured manually from surface ECG before onset of arrhythmia) and right ventricular end diastolic diameter from magnetic resonance imaging (RVEDD, MRI) (transaxial views at mid-ventricular frames), suggesting a possible mechano-electric interaction in adult patients after the Mustard procedure.

Selected References

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