{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T09:34:28Z","timestamp":1774863268470,"version":"3.50.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Theo-Rossi di Montelera (TRM) foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Cardiac dyssynchrony in patients with repaired Tetralogy of Fallot (rToF) has been attributed to right bundle branch block (RBBB), fibrosis and\/or the patches that are inserted during repair surgery. We aimed to investigate the basis of abnormal activation in rToF patients by mapping the electrical activation sequence during sinus rhythm (SR) and right ventricular (RV) pacing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and Results<\/jats:title>\n                  <jats:p>A total of 17 patients were studied [13 with rToF, 2 with left bundle branch block (LBBB), and 2 without RBBB or LBBB (non-BBB)] during medically indicated cardiac surgery. During SR and RV pacing, measurements were performed using 112-electrode RV endocardial balloons (rToF only) and biventricular epicardial sock arrays (four of the rToF and all non-rToF patients). During SR, functional lines of block occurred in five rToF patients, while RV pacing caused functional blocks in four rToF patients. The line of block persisted during both SR and RV pacing in only 2 out of 13 rToF patients. Compared to SR, RV pacing increased dispersion of septal activation, but not dispersion of endocardial and epicardial activation of the RV free wall. During pacing, RV and left ventricular activation dispersion in rToF patients were comparable to that of the non-rToF patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The results of the present study indicate that the delayed activation in the right ventricle of rToF patients is predominantly due to block(s) in the Purkinje system and that conduction in RV tissue is fairly normal.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euaa400","type":"journal-article","created":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T04:48:39Z","timestamp":1607143719000},"page":"i105-i112","source":"Crossref","is-referenced-by-count":9,"title":["Exploring the cause of conduction delays in patients with repaired Tetralogy of Fallot"],"prefix":"10.1093","volume":"23","author":[{"given":"Nienke J","family":"Verzaal","sequence":"first","affiliation":[{"name":"Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"St\u00e9phane","family":"Mass\u00e9","sequence":"additional","affiliation":[{"name":"The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene","family":"Downar","sequence":"additional","affiliation":[{"name":"The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kumaraswamy","family":"Nanthakumar","sequence":"additional","affiliation":[{"name":"The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6897-9700","authenticated-orcid":false,"given":"Tammo","family":"Delhaas","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frits W","family":"Prinzen","sequence":"additional","affiliation":[{"name":"Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"2021031001583218900_euaa400-B1","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/S0140-6736(09)60657-7","article-title":"Tetralogy of Fallot","volume":"374","author":"Apitz","year":"2009","journal-title":"Lancet"},{"key":"2021031001583218900_euaa400-B2","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S1525-2167(03)00053-2","article-title":"Right ventricular myocardial activation delay in adult patients with right bundle branch block late after repair of Tetralogy of Fallot","volume":"5","author":"D\u2019Andrea","year":"2004","journal-title":"Eur J Echocardiogr"},{"key":"2021031001583218900_euaa400-B3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1161\/01.CIR.62.2.319","article-title":"Postoperative right bundle branch block: identification of three levels of block","volume":"62","author":"Horowitz","year":"1980","journal-title":"Circulation"},{"key":"2021031001583218900_euaa400-B4","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1161\/01.CIR.59.6.1241","article-title":"The mechanism of apparent right bundle branch block after transatrial repair of Tetralogy of Fallot","volume":"59","author":"Horowitz","year":"1979","journal-title":"Circulation"},{"key":"2021031001583218900_euaa400-B5","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1161\/01.CIR.51.6.1026","article-title":"Postoperative left anterior hemiblock and right bundle branch block following repair of Tetralogy of Fallot. 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