Development And Validation Of A Tool Aimed At Quantifying Cardiac Conduction Health
Stephanie Tuttle, MS, Abhijit Mondal, PhD, Kimberlee Gauvreau, ScD, Robert Hitchcock, PhD, Frank Sachse, PhD, Elizabeth DeWitt, MD, Edward O'Leary, MD, Douglas Mah, MD, Meena Nathan, MD, Aditya Kaza, MD.
Boston Children's Hospital, Boston, MA, USA.
Objective Surgical advancements have improved survival rates for patients with congenital heart defects. Unparalleled, patients still experience significant comorbidities such as requiring a permanent pacemaker. To improve understanding of overall conduction health, we aimed to develop and validate a ranking tool applied to congenital heart surgery (CHS) patients. MethodsWe conducted a randomly sampled, retrospective review of patients aged 0 to 7 years, with at least 1 year of follow-up data, undergoing repair of ventricular septal defect (VSD, n = 45) and tetralogy of Fallot (TOF, n = 34) between 2010 and 2013. Patients with prior CHS and pacemaker implantation were excluded. Electrocardiograms and resultant conduction health Global Rank Score (chGRS) were analyzed. The chGRS is based on a range of severity, from 1 (most severe) to 7 (least severe), and includes conduction parameters such as complete heart block and superior axis deviation.Results The VSD and TOF patients exhibited a significant decrease in chGRS from pre-surgery to hospital discharge with 2% with scores <7 pre-surgery increasing to 49% post-surgery, and 15% with scores <7 pre-surgery increasing to 62% post-surgery (p<0.001), respectively. There was no significant difference in chGRS from hospital discharge to long-term follow-up (range: 1.7 to 10.6 years) for either group. Conclusion Cardiac chGRS can help quantify the impact of CHS on the conduction system. Further studies are needed to validate this across the spectrum of CHS. This can be an effective tool to quantitate the effect of strategies aimed at preserving conduction during CHS.
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