Vaksmann G, el Kohen M, Brevière G M, Rey C, Francart C, Chammas E, Dupuis C
Service de cardiologie infantile, hôpital cardiologique, Lille.
Arch Mal Coeur Vaiss. 1990 May;83(5):659-63.
The prevalence and factors favorising postoperative ventricular arrhythmias in 62 patients undergoing surgical repair of tetralogy of Fallot between 1971 and 1982 were analysed. Nineteen patients (31 %) had significant ventricular arrhythmias (Lown greater than or equal to 2) on Holter monitoring or exercise stress testing. The arrhythmia could only be recorded after stress testing in 5 patients. The patient's age at operation, the duration of follow-up and age at evaluation were significantly greater in the group with ventricular arrhythmias. However, age at operation was closely related to the other two parameters and a discriminating analysis showed that the age at operation was not a favorising factor for the occurrence of ventricular arrhythmias (p = 0.23), in contrast to the duration of follow-up (p = 0.0015) and age at evaluation (p = 0.0007). No relationship was found between ventricular arrhythmias and the following factors: previous anastomosis, outflow patch, necessity of a ventriculotomy or reoperation, presence of residual ventricular septal defect, postoperative systolic right ventricular pressure, severity of intraventricular conduction defects, and effort tolerance. These results suggest that after surgical repair of tetralogy of Fallot, the incidence of ventricular arrhythmias increases with time. The main problem is to identify patients with a high risk of sudden death, i.e. those with high degree ventricular arrhythmias and poor haemodynamic results of repair.
分析了1971年至1982年间62例接受法洛四联症手术修复患者术后室性心律失常的患病率及相关因素。19例患者（31%）在动态心电图监测或运动负荷试验中出现显著室性心律失常（Lown分级大于或等于2级）。5例患者仅在负荷试验后才记录到心律失常。室性心律失常组患者的手术年龄、随访时间和评估时的年龄显著更大。然而，手术年龄与其他两个参数密切相关，判别分析表明手术年龄并非室性心律失常发生的相关因素（p = 0.23），而随访时间（p = 0.0015）和评估时的年龄（p = 0.0007）是相关因素。未发现室性心律失常与以下因素之间存在关联：既往吻合术、流出道补片、心室切开术或再次手术的必要性、残余室间隔缺损的存在、术后右心室收缩压、室内传导缺陷的严重程度以及运动耐量。这些结果表明，法洛四联症手术修复后，室性心律失常的发生率随时间增加。主要问题是识别猝死高危患者，即那些有高度室性心律失常且修复后血流动力学结果不佳的患者。
