Seipel L, Borggrefe M, Horstkotte D, Kühlkamp V, Ostermeyer J
Abt. Inn. Med. III, Universitätsklinik Tübingen.
Z Kardiol. 1989;78 Suppl 7:53-64.
As a result of the intraoperative trauma sinus node dysfunction and AV conduction defects have been observed. In addition bifascicular block (RBBB with LAH) may occur after repair of a ventricular septal defect. This electrocardiographic pattern indicates a high risk of developing a trifascicular block only in those patients with reversible AV block in the early postoperative period. After closure of an atrial septal defect, atrial fibrillation can develop as well as ventricular tachycardia and fibrillation after repair of a ventricular septal defect. The latter seems to be the underlying mechanism of sudden cardiac death occurring late after operation, especially in patients with Fallot tetralogy. In addition to the scar, persistent structural myocardial changes seem to be an important factor. Electrophysiological investigation is indicated in all symptomatic patients especially for detection and treatment of ventricular tachyarrhythmias. However, there is yet no proof that sudden death can be prevented by antiarrhythmic treatment of all ventricular premature beats in the endangered patients.
由于术中创伤，已观察到窦房结功能障碍和房室传导缺陷。此外，室间隔缺损修复后可能会出现双分支阻滞（右束支传导阻滞合并左前分支阻滞）。这种心电图模式仅在术后早期有可逆性房室传导阻滞的患者中提示发生三分支阻滞的高风险。房间隔缺损闭合后，可发生心房颤动，室间隔缺损修复后可发生室性心动过速和颤动。后者似乎是术后晚期发生心源性猝死的潜在机制，尤其是法洛四联症患者。除瘢痕外，持续的结构性心肌改变似乎也是一个重要因素。所有有症状的患者均需进行电生理检查，尤其是用于检测和治疗室性快速心律失常。然而，尚无证据表明通过对濒危患者的所有室性早搏进行抗心律失常治疗可预防猝死。
