Abstract
The electrocardiogram (ECG) and vectorcardiogram (VCG) have been used as a predictor of right ventricular pressure (RVP) elevation. However, in cases of postoperative (PO) tetralogy of Fallot (TF), the correlation between the ECG and VCG and increased RVP remains controversial due to the ECG pattern of right bundle branch block (RBBB). 21 patients (pts) with TF with PO RBBB by ECG, 3 to 17 yrs, who underwent cardiac catheterization at least 1 year PO, were evaluated. All 21 had ECG's while 11 had VCG's. Group A included 9 pts (4 with VCG) whose RVP ≥ 46mmHG; Group B included 12 pts (7 with VCG) whose RVP ≥ 45mmHG. Multiple ECG and VCG parameters were compared to RVP. Among Group A pts with VCG, the right maximal spatial voltage (RMSV) and the terminal anterior forces (TAF) were both greater than lmV (mean 1.2mV and 1.52mV, respectively) in all pts. In Group B, the RMSV was less than lmV (mean 0.61mV) in 11 of 11 pts, while the TAF was less than 1mV (mean 0.67mV) in 10 of 11. On the ECG of Group A, 55% of patients had a qR pattern in V1 (0% in Group B), while 45% had a right superior axis (RSA) (10% in Group B). Numerous other ECG and VCG parameters measured were not useful. Thus, the RMSV and the TAF of the VCG appear helpful in predicting residual RVP elevation, while the ECG, except for the presence of a qR in V1 or RSA, is not helpful.
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