Objective: In this study, we aimed to investigate the ECG findings in patients with operated tetralogy of fallot and to investigate the relationship between these findings andcomplications

OBJECTIVE: In this study, we aimed to investigate the ECG findings in patients with operated Tetralogy of Fallot and to investigate the relationship between these findings and complications. MATERIAL AND METHODS: Between January 2006 and December 2014, the patients who underwent complete correction operation between 0-18 years of age with Tetralogy of Fallot at Ege University Hospital were recorded. The data of these cases in the archive files were analyzed retrospectively. The subjects in which their cases without operation report, postoperative echocardiography report, catheterization information, previous palliative operative information, preoperative and postoperative electrocardiography and Holter electrocardiogram record results were excluded from the study. 38 subjects were included in the list. The subjects' parents were informed about study with informed consent form and by the researcher. First, demographic and clinical data were recorded, after that echocardiographic data and ECG parameters were recorded for each case. Data were analyzed with SPSS v18.0 programme. RESULTS: The median age of the subjects was 9 years (range: 4-21). 15 were female and 23 were male. Palliative modified Blalock-Taussing (MBT) shunt was applied in 16 subjects before total correction operation. RVOT widening was performed in 13 subjects with graft, 3 with pericardial patch and 22 with transanular patch. 3 subjects had <15mmHg pulmonary gradient, 28 subjects had 15-29 mmHg (mild), 6 subjects had 30-49mmHg (moderate) and 1 subject had 50 mmHg (severe) pulmonary stenosis (PS). No patient with > 50 mmHg gradient was detected. In addition, 12 patients had moderate and 1 patient had severe pulmonary insufficiency (PI). 5 of 13 patients with moderate-severe PI were also observed to have a PS gradient ≥ 30mmHg. No relationship was found between the operation types and PS or PI development. Postoperative QRS duration was increased in all cases. QRS periods were > 120 ms in 15.8% of patients in the preoperative period, 28.9% at postoperative first year, 39.5% at postoperative 2nd year and 55.3% at postoperative 3rd year. A positive correlation was found between the degree of PI and QRS duration, especially in the postoperative 3rd year (p=0.03). There was no correlation between prolongation of QRS and the degree of PS (p> 0.05). While PR was observed to be increased in all patients, there was no correlation between operation type, PS and PI degrees (p> 0.05). P dispersion was found to be within normal limits (<40 msec) but there was no significant difference between the groups in the postoperative period. In the preoperative and postoperative comparisons of the QRS axis was shifted to the left in the postoperative period in subjects with moderate or severe PI and the right axis persisted in patients with PS ≥30 mmHg. QTc duration was increased in all cases, but no correlation was found with other findings and arrhythmia. QTd did not show a steady decrease or increase in the postoperative period; and had no correlation with the operation types and other findings. At postoperative 3rd year, 31 patients (81.57%) had RBBB, 6 patients (15.7%) had incomplete right bundle branch block and 1 patient (2.6%) had first degree AV block. Holter electrocardiography showed VEP in 1 patient (less than 5% of normal rhythm duration) and intermittent ectopic rhythm in 1 patient. CONCLUSION: In our study, the correlations between postoperative PS and PI rates and prolongation of QRS were found to be similar to other studies. No patient had a QRS duration >180 msec detected. In addition, we think that arrhythmia incidence and QT dispersion are lower than the other studies because of inadequate number of patients and shorter follow-up period compared to other studies. It should be kept in mind that more patients should be evaluated for longer periods of time to define postoperative complications and ECG findings after major cardiovascular interventions. KEYWORDS: Tetralogy of Fallot, total correction, prolongation of QRS, early follow-up, complications of operation, arrhythmia, ECG