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The changes in signal-averaged electrocardiogram after surgical correction of congenital heart disease

Korean Journal of Pediatrics 2009;52(12):1364-1369.
Published online December 15, 2009.
The changes in signal-averaged electrocardiogram after surgical correction of congenital heart disease
Yeo Hyang Kim1, Hee Jung Choi3, Gun Jik Kim4, Joon Yong Cho4, Myung Chul Hyun2, Sang Bum Lee2
1Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
2Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
3Department of Pediatrics, Gumi CHA General Hospital, Gumi, Korea
4Department of Thoracic and Cardiovascular Surgery, Kyungpook National University School of Medicine, Daegu, Korea
선천성 심장병의 개심술 후 신호 평준화 심전도의 변화
김여향1, 최희정3, 김근직4, 조준용4, 현명철2, 이상범2
1계명대학교 의과대학 소아과학교실
2경북대학교 의과대학 소아과학교실
3포천중문의과대학 구미차병원 소아청소년과
4경북대학교 의학전문대학원 흉부외과학교실
Correspondence: 
Myung Chul Hyun, Email: mchyun@mail.knu.ac.kr
Abstract
Purpose
: To analyze abnormal ventricular activation in childhood congenital heart disease induced by postoperative changes in ventricular volume and pressure and ventricular scar formation using signal-averaged electrocardiography (SAECG).
Methods
: Fifty-two patients who had undergone open heart surgery (OHS) were enrolled. Patients were divided into the following 3 groups: right ventricular volume overload (atrial septal defect, group1), left ventricular volume overload (ventricular septal defect, group2), and right ventricular pressure overload (tetralogy of Fallot, group 3). The patients were monitored by standard 12-lead ECG and SAECG before and 2 months after the operation. QRS duration, QT and QTc intervals, filtered QRS (f-QRS), high frequency low amplitude potential (HFLA), and root mean square (RMS) voltage in the terminal 40 ms of SAECG were determined.
Results
: In the preoperative period, group1 showed significant increase in QRS (P=0.011) compared to those of the other 2 groups. In the postoperative period, group3 showed significant increase in the QTc interval (P=0.004) compared to those in the other 2 groups. SAECG parameters showed no significant differences among the groups in the pre- or postoperative period. Of the 52 patients, 12 (23%) in the preoperative period and 21 (40%) in the postoperative period had at least 1 SAECG abnormality. The prevalence of SAECG abnormalities was significantly higher in the postoperative group 2 and group 3 (preoperative: 20% versus postoperative: 28%, P<0.001, preoperative: 14% versus postoperative: 64%, P<0.001, respectively).
Conclusion
: Abnormal SAECG patterns may be attributed to postoperative scars, OHS itself, and/or ventricular overload.
Key Words: Congenital heart disease, Signal-averaged electrocardiography, Open heart surgery


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