Zamora C, Falcón B, Martínez Ríos M A, Cárdenas M, Mata L A
Arch Inst Cardiol Mex. 1976 Nov-Dec;46(6):720-32.
A study was made of the electric activity of the atrioventricular (AV) conduction system in basal conditions and with atrial stimulation in order to discover the type, severity and prognosis of the AV disturbance in cases of total correction of tetralogy of Fallot. The authors studied thirteen patients from the Paediatric Department of the National Institute of Cardiology who had undergone such surgery, 7 males, 6 females from 3 to 22 years old. All presented advanced RBBB and sinus rhythm; in the immediate postoperative period, one presented complete transitory A-V block which required a stand by pacemaker; in 2 cases there was a first degree AV block; in two other, LAH and LPH. In 5 cases atrial stimulation was made with single charges and progressive frequency. Measurements were taken at the customary intervals. In basal conditions, prolongation of the AH interval was only found in 2 patients, both with first degree AV block in the peripheral EKG; both patients were taking digitalis. The HV interval was longer than normal in 3 cases, with one of these showing also a lengthened AH interval. The atrial stimulation showed prolonged ventricular activation in 2 cases, one of them with normal basal HV interval. The authors conclude that this procedure permits: 1) The discovery of alterations in the AV conduction system which could not be found in a peripheral EKG. 2) Localization of the site of the lesion. 3) The finding of disturbances of the ventricular conduction by atrial stimulation. 4) Identification of those patients who, after a complete correction of tetralogy of Fallot, show a potential high risk of developing complete complete AV block or of sudden death. 5) The establishment of a real prognosis in these patients.
为了明确法洛四联症完全矫正术后房室传导障碍的类型、严重程度及预后，对基础状态下及心房刺激时的房室（AV）传导系统电活动进行了研究。作者研究了国立心脏病研究所儿科的13例接受此类手术的患者，其中男性7例，女性6例，年龄在3至22岁之间。所有患者均表现为晚期右束支传导阻滞及窦性心律；术后即刻，1例出现完全性暂时性房室传导阻滞，需要备用起搏器；2例出现一度房室传导阻滞；另外2例出现左前分支阻滞和左后分支阻滞。5例患者进行了单次充电及递增频率的心房刺激。按常规间隔进行测量。在基础状态下，仅2例患者发现AH间期延长，这2例患者外周心电图均有一度房室传导阻滞，且均服用洋地黄。3例患者的HV间期长于正常，其中1例AH间期也延长。心房刺激显示2例患者心室激动延迟，其中1例基础HV间期正常。作者得出结论，该方法能够：1）发现外周心电图无法发现的房室传导系统改变。2）确定病变部位。3）通过心房刺激发现心室传导障碍。4）识别那些法洛四联症完全矫正术后有发生完全性房室传导阻滞或猝死潜在高风险的患者。5）确定这些患者的实际预后。
