Congenital Heart Disease
Follow-Up of Electrocardiographic Findings and Arrhythmias in Patients With Anomalously Arising Left Coronary Artery from the Pulmonary Trunk

https://doi.org/10.1016/j.amjcard.2016.08.022Get rights and content

Follow-up data and correlation of arrhythmias, electrocardiogram (ECG) changes, and cardiac function in anomalous left coronary artery from the pulmonary trunk or artery have not been previously studied. This is a retrospective single-center review of 44 anomalous left coronary artery from the pulmonary trunk or artery patients diagnosed between 1992 and 2014, at a median age of 3 months (3 days to 13 years). Clinical history, ECG, Holter, and echocardiogram data were reviewed. ECGs were reviewed for contiguous Q-or T-wave inversions, hypertrophy, bundle branch block, and axis deviation. High-grade ventricular ectopy, supraventricular tachycardia (SVT), and ventricular tachycardia (VT) were recorded. Patients with <6 months of clinical follow-up were excluded from longitudinal analysis. At diagnosis, 43 (98%) were noted to have electrocardiographic changes. During hospitalization, arrhythmias were seen in 13 patients (30%): 2 (5%) with sustained VT or ventricular fibrillation, 6 (17%) with high-grade ventricular ectopy, and 4 (9%) with SVT. Seven patients (16%) required antiarrhythmic treatment. During outpatient follow-up, arrhythmias were seen in 11 patients. New arrhythmias were documented in 6 without a history of in-hospital arrhythmias. Of 34 patients with at least 6 months follow-up (median 6 years, 0.5 to 20 years), 20 had left ventricular (LV) dysfunction before surgery. Normalization of function occurred in 94% (median 1 year, 5 days to 4 years). Electrocardiographic changes persisted in 94% at the time of LV function recovery. In conclusion, electrocardiographic changes and arrhythmias may persist despite recovery of ventricular function. Therefore, prolonged myocardial remodeling may continue even after resolution of LV dysfunction during which time arrhythmias may occur.

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Methods

This was a retrospective single-center review of patients at Texas Children's Hospital diagnosed with ALCAPA between 1992 and 2014. Patients were excluded if they did not have an available presurgical electrocardiogram (ECG) or if they had significant congenital heart disease in addition to ALCAPA. All patients with less than 6 months of outpatient cardiology follow-up were omitted from analysis of longitudinal trends but remained a component of the presurgical ECG and arrhythmia data analysis.

Results

A total of 44 patients with ALCAPA (21 men, 48%) with available preoperative ECGs were diagnosed at a median age of 3 months (3 days to 13 years). Table 1 summarizes patient demographics and presentation. Nearly all patients (98%) had some electrocardiographic findings, although changes were not consistently seen among all patients. The most common electrocardiographic finding at presentation was deep Q waves and T-wave inversions (Table 2).

Electrocardiographic follow-up was available in 34 of

Discussion

This study provides insight into the correlation between electrocardiographic changes, arrhythmias, and LV systolic function in ALCAPA patients over time. Our population appears to be congruent with previous ALCAPA studies in regards to age at diagnosis, timing of surgery, and morbidity as well as mortality. Based on the cumulative data presented in Table 2, deep Q waves in the lateral leads appear to be the most sensitive indicator when considering a diagnosis of ALCAPA; however, 20% of our

Disclosures

The authors have no conflicts of interest to disclose.

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