Lan Yueh-Tze, Lee Joselyn C R, Wetzel Glenn
Division of Pediatric Cardiology, David Geffen School of Medicine at the University of California-Los Angeles, USA.
Curr Opin Cardiol. 2003 Mar;18(2):73-8. doi: 10.1097/00001573-200303000-00001.
Postoperative arrhythmia is a major cause of morbidity and mortality after cardiac surgery for congenital heart disease. Rhythm disturbances that may be well tolerated in a normal heart often cause hemodynamic instability when they occur in the immediate postoperative period. In the face of pre-existing myocardial dysfunction resulting from preoperative pressure or volume overload, patients with congenital heart conditions are especially vulnerable to rhythm disturbances after cardiac surgery. Cardiopulmonary bypass, intraoperative injury to the conduction system and myocardium, postoperative metabolic abnormalities, electrolyte disturbances, and increased adrenergic tone in response to the stress of the surgery or inotropic agents are also known factors associated with increased risk of arrhythmia in the immediate postoperative period. Surgically related arrhythmia can also present in the late postoperative period, particularly in association with surgical incision sites and surgically induced hemodynamic abnormalities. Early and late postoperative arrhythmias are important risk factors for morbidity and mortality after surgical treatment of many forms of congenital heart disease. This review describes the incidence of the most common forms of arrhythmia and recent advances in their diagnosis and treatment.
术后心律失常是先天性心脏病心脏手术后发病和死亡的主要原因。在正常心脏中可能耐受性良好的节律紊乱，在术后即刻发生时往往会导致血流动力学不稳定。面对术前压力或容量超负荷导致的心肌功能障碍，先天性心脏病患者在心脏手术后尤其容易发生节律紊乱。体外循环、术中对传导系统和心肌的损伤、术后代谢异常、电解质紊乱以及手术应激或使用正性肌力药物导致的肾上腺素能张力增加，也是术后即刻心律失常风险增加的已知相关因素。与手术相关的心律失常也可能出现在术后晚期，特别是与手术切口部位和手术引起的血流动力学异常有关。术后早期和晚期心律失常是多种先天性心脏病手术治疗后发病和死亡的重要危险因素。本综述描述了最常见心律失常形式的发生率及其诊断和治疗的最新进展。
