Pahlajani D B, Serratto M, Mehta A, Miller R A, Hastreiter A, Rosen K M
Circulation. 1975 Jul;52(1):82-7. doi: 10.1161/01.cir.52.1.82.
Electrophysiological studies were performed in 18 patients who developed bifascicular block after repair of ventricular septal defect (VSD) or tetralogy of Fallot (TF). Two had transient complete heart block (CHB) in the immediate postoperative period. The P-A intervals were normal in all. A-H and H-V intervals were prolonged in three and four cases, respectively. Atrial pacing at progressively increasing heart rates was performed in 15 patients; two developed type II block distal to the His bundle (H). The effective and functional refractory periods (ERP and FRP) of the atrium (11 cases) were normal in all. The ERP of the A-V node (seven cases) was prolonged in found and the FRP was increased in three. The ERP of the ventricular specialized conduction system was measured in two cases and was prolonged in one. In all, seven cases had abnormalities indicating disease of the A-V node and/or His-Purkinje system. Recording of intervals, atrial pacing, and determination of refractory periods (RPs) was necessary to reveal all conduction abnormalities. One patient died of unrelated causes. The others are alive and in sinus rhythm with intact conduction 3 to 16.5 years following surgery (mean follow-up of 8.3 plus or minus 0.95 years). The clinical course in patients with normal and abnormal findings was equally benign. Prophylactic insertion of demand pacemakers does not appear indicated in these patients.
对18例在室间隔缺损（VSD）或法洛四联症（TF）修复术后出现双分支阻滞的患者进行了电生理研究。2例在术后即刻出现短暂性完全性心脏传导阻滞（CHB）。所有患者的P-A间期均正常。A-H间期延长的有3例，H-V间期延长的有4例。对15例患者进行了逐渐增加心率的心房起搏；2例在希氏束（H）远端出现Ⅱ型阻滞。所有11例心房的有效不应期和功能不应期（ERP和FRP）均正常。7例房室结的ERP延长，3例FRP增加。对2例心室特殊传导系统的ERP进行了测量，1例延长。总之，7例存在提示房室结和/或希氏-浦肯野系统疾病的异常。记录间期、心房起搏以及测定不应期（RPs）对于发现所有传导异常是必要的。1例患者死于无关原因。其他患者术后3至16.5年仍存活且为窦性心律，传导功能正常（平均随访8.3±0.95年）。有正常和异常表现的患者临床病程同样良好。这些患者似乎无需预防性植入按需起搏器。
