Objective Adults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up. Methods We included TOF-operated patients≥18 years from our centre’s registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator. Results We included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, −15.8±3.1% vs −18.8±3.2%, p=0.001) and right ventricular (RV) GLS (−15.8±3.9% vs −19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (−18.1±4.0 ms vs −16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p<0.001) were associated with higher incidence of VA. QRS duration was longer in men (151±30 ms vs 128±25 ms, p<0.001). No patients had QRS duration >180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06). Conclusions Our results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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法洛四联症手术成人的长期随访和性别差异

目的法洛四联症（TOF）手术成人室性心律失常（VA）的风险很高。QRS 持续时间 > 180 ms 是 VA 的既定风险因素。我们旨在调查长期随访中 TOF 患者的心脏功能、心律失常患病率和性别差异。方法 我们从我们中心的登记处纳入了≥18 岁的 TOF 手术患者。我们回顾了医疗记录和最近的超声心动图检查。VA 记录在心电图、24 小时动态心电图和植入式心脏复律除颤器上。结果 我们纳入了 148 名患者（年龄 37±10 岁）。左心室整体纵向应变（LV GLS，-15.8±3.1% vs -18.8±3.2%，p=0.001）和右心室（RV）GLS（-15.8±3.9% vs -19.1±4.1%，p=0.001）分别为与女性相比，所有年龄段的男性都较低。更高的 RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), 较低的射血分数（55%±8% 对 50%±9%，p=0.02），较低的 RV GLS（-18.1±4.0 ms 对 -16.1±4.8 ms，p=0.04）和 N 端脑利钠肽前体(NT-proBNP) 超过参考范围 (n=27 (23%) vs n=8 (77%), p<0.001) 与更高的 VA 发生率相关。男性的 QRS 持续时间更长（151±30 ms vs 128±25 ms，p<0.001）。没有患者的 QRS 持续时间 > 180 ms。QRS 持续时间在有和没有 VA 的患者中没有差异（143±32 ms vs 137±28 ms，p=0.06）。结论 我们的结果证实了接受 TOF 手术的成人 RV 功能降低。男性患者的 LV 和 RV 功能受损，表现为所有年龄段的 LV 和 RV GLS 值较低。心脏功能降低和 NT-proBNP 升高与 VA 发生率较高相关，并且可能在风险评估中很重要。