Harrison D A, Siu S C, Hussain F, MacLoghlin C J, Webb G D, Harris L
University of Toronto Congenital Cardiac Centre for Adults, The Toronto General Hospital, and University of Toronto, Ontario, Canada.
Am J Cardiol. 2001 Mar 1;87(5):584-8. doi: 10.1016/s0002-9149(00)01435-1.
We determined the prevalence of sustained atrial tachyarrhythmia (AT) in adults late after repair of tetralogy of Fallot (ToF) and examined its impact on subsequent heart failure, reoperation, and mortality. Ventricular arrhythmias are associated with increased morbidity and mortality in patients with repair of ToF. The clinical impact of AT in this population has not been established. A retrospective cohort study of 242 patients with repaired ToF identified 29 patients (prevalence of 12%) with sustained episodes of AT. Patients with repaired ToF but without sustained arrhythmia (n = 213) constituted a comparison group. Baseline characteristics and clinical outcomes in the 2 groups were compared. An echocardiographic analysis compared 15 patients with AT and 15 matched for age at operation and timing of echocardiography. The development of AT was associated with substantial morbidity including congestive heart failure, reoperation, subsequent ventricular tachycardia, stroke, and death (combined events, 20 of 29 patients [69%]). The rate of combined events (congestive heart failure, stroke, and deaths) in the 213 "arrhythmia-free" patients was 30% (64 of 213 patients). Event-free survival after repair was 18 +/- 2 years for the AT group and 28 +/- 1 years for the arrhythmia-free group (p < 0.001). Patients with AT were older at surgical repair (25 +/- 16 vs 10 +/- 9 years, p = 0.001), and at most recent assessment were aged 48 +/- 12 vs 32 +/- 10 years (p = 0.001). The AT group had a higher mean right atrial volume and proportion of significant pulmonary regurgitation than matched controls. The development of AT in the adult late after ToF repair identifies patients at risk and is associated with older age at repair, a higher frequency of hemodynamic abnormalities, and increased morbidity.
我们确定了法洛四联症（ToF）修复术后成人持续性房性快速心律失常（AT）的患病率，并研究了其对后续心力衰竭、再次手术和死亡率的影响。室性心律失常与ToF修复术后患者的发病率和死亡率增加相关。AT在该人群中的临床影响尚未明确。一项对242例ToF修复患者的回顾性队列研究确定了29例（患病率为12%）有持续性AT发作的患者。ToF修复但无持续性心律失常的患者（n = 213）构成对照组。比较了两组的基线特征和临床结局。超声心动图分析比较了15例AT患者和15例年龄及超声心动图检查时间匹配的患者。AT的发生与包括充血性心力衰竭、再次手术、随后的室性心动过速、中风和死亡在内的严重发病率相关（联合事件，29例患者中的20例[69%]）。213例“无心律失常”患者的联合事件（充血性心力衰竭、中风和死亡）发生率为30%（213例患者中的64例）。AT组修复后的无事件生存期为18±2年，无心律失常组为28±1年（p < 0.001）。AT患者手术修复时年龄较大（25±16岁 vs 10±9岁，p = 0.001），最近一次评估时年龄为48±12岁 vs 32±10岁（p = 0.001）。与匹配的对照组相比，AT组的平均右心房容积和严重肺反流比例更高。ToF修复术后晚期成人发生AT可识别出有风险的患者，并与修复时年龄较大、血流动力学异常频率较高和发病率增加相关。
