Tesis

Hubungan Fragmentasi QRS Terhadap Kejadian Aritmia Ventrikel Berpotensi Maligna pada Pasien Pasca Koreksi Tetralogi Fallot = Association Between QRS Fragmentation and Potentially Malignant Ventricular Arrhythmias in Repaired Tetralogy of Fallot.

Latar belakang: Prevalensi aritmia ventrikel maligna dan sudden cardiac death pasca koreksi Tetralogi Fallot (TOF) masih tinggi. Fragmentasi QRS derajat berat merupakan salah satu faktor independen terhadap mortalitas pasca koreksi TOF. Deteksi dini dan stratifikasi risiko aritmia pasca operasi dapat dilakukan dengan menggunakan perekaman holter EKG. Sayangnya modalitas ini tidak tersedia luas di seluruh pelayanan kesehatan. Perlu adanya studi yang menilai hubungan antara fragmentasi QRS berat yang dinilai dengan menggunakan EKG 12 sadapan dengan kejadian aritmia ventrikel pasca koreksi TOF. Tujuan: Penelitian ini bertujuan untuk mengetahui manfaat EKG sebagai modalitas sederhana dan tersedia luas dalam menilai hubungan antara fragmentasi QRS terhadap kejadian aritmia ventrikel berpotensi maligna pada pasien pasca koreksi TOF Metode: Studi observasional (potong lintang) pada 59 pasien pasca koreksi TOF > 1 tahun dari waktu operasi. Dilakukan pemeriksaan EKG 12 sadapan untuk menilai derajat fragmentasi QRS dan dinilai hubungannya dengan temuan aritmia ventrikel berpotensi maligna dari holter EKG 24 jam. Fragmentasi QRS pada penelitian ini diklasifikasikan sebagai berat (fragmentasi > 5 sadapan) dan tanpa fragmentasi berat (0–5 sadapan). Hasil: Terdapat 59 subyek penelitian dengan rerata usia 193 + 151 bulan. Sebesar 37,3% pasien menjalani operasi koreksi TOF pada usia > 3 tahun. Terdapat 89,8% subyek dengan fragmentasi QRS, dan 57,6% diantaranya dengan fragmentasi QRS berat. Kejadian aritmia ventrikel berpotensi maligna ditemukan pada 40,7% subyek, dan 45,8% diantaranya tidak mempunyai keluhan. Berdasarkan analisis multivariat, didapatkan fragmentasi QRS derajat berat (OR 8,6[95% IK1,9 – 39,5]) dan interval operasi > 7 tahun (OR 8,9[95% IK2,2 – 35,9]) merupakan faktor independen terjadinya aritmia ventrikel (p < 0,05). Kesimpulan: Terdapat hubungan antara derajat fragmentasi QRS berat dengan kejadian aritmia ventrikel berpotensi maligna, dengan besar risiko delapan kali dibanding pasien tanpa fragmentasi QRS berat.
Kata Kunci: fragmentasi QRS, aritmia ventrikel, tetralogi fallot


Background: The prevalence of malignant ventricular arrhythmias and sudden cardiac death after Tetralogy of Fallot (TOF) repair is staggeringly high. Severe QRS fragmentation has been associated as one of the independent factors for mortality after TOF repair. Through ECG holter monitoring, early detection and risk stratification for post-operative arrhythmia complication can be achieved. Unfortunately, this modality is not widely available in all healthcare services. Further study is necessary to evaluate the association between severe QRS fragmentation from 12-leads ECG and the incidence of ventricular arrhythmias after TOF repair from holter ECG. Objective: To determine the benefit of ECG in assessing the association between QRS fragmentation and the incidence of potentially malignant ventricular arrhythmias. Methods: This cross-sectional observational study was done in 59 repaired TOF patients > 1 year from time of surgery. ECG was performed to evaluate QRS fragmentation severity and 24-hour Holter ECG was assessed to associate the potentially malignant ventricular arrhythmias. QRS fragmentation was defined as notches in QRS complex and classified as severe QRS fragmentation ( > 5 leads) and none-to-moderate QRS fragmentation (0 – 5 leads). Results: There were 59 subjects with mean age of 193 + 151 months, 37.3% of patients underwent surgery > 3 years of age. QRS fragmentation was found in 89.8% of subjects, and 57.6% presented with severe QRS fragmentation. The incidence of potentially malignant ventricular arrhythmias was 40.7%, but 45.8% of ventricular arrhythmia patients were asymptomatic. On multivariate analysis, severe QRS fragmentation (OR 8,6[95% CI1,9 – 39,5]) and over than 7 years of operating intervals (OR 8,9[95% CI2,2 – 35,9]) were found as independent factors for ventricular arrhythmia occurrence (p < 0.05). Conclusion: There is an association between severe QRS fragmentation and the incidence of potentially malignant ventricular arrhythmias, with an eight times greater risk in patients with none-to-moderate QRS fragmentation.
Keywords: fragmentation QRS, ventricular arrhythmia, tetralogi of fallot