Feins Eric N, O'Leary Edward T, Davee Jocelyn, Gauvreau Kimberlee, Hoganson David M, Schulz Noah, Eickoff Emily, Triedman John K, Baird Christopher W, Del Nido Pedro J, Emani Sitaram, DeWitt Elizabeth S
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 2023 May;165(5):1618-1628. doi: 10.1016/j.jtcvs.2022.11.033. Epub 2022 Dec 13.
The study objectives were to report on a growing experience of conduction system mapping during complex congenital heart surgery and create a predictive model of conduction anatomy.
Patients undergoing complex cardiac repair with conduction mapping were studied. Intraoperative mapping used a multielectrode catheter to collect His bundle electrograms in the open, decompressed, beating heart. Patient anatomy, operative details, His bundle location, and postoperative conduction status were analyzed. By using classification and regression tree analysis, a predictive model of conduction location was created.
A total of 109 patients underwent mapping. Median age and weight were 1.8 years (range, 0.2-14.9) and 10.8 kg (range, 3.5-50.4), respectively. Conduction was identified in 96% (105/109). Median mapping time was 6 minutes (range, 2-33). Anatomy included atrioventricular canal defect, double outlet right ventricle, complex transposition of the great arteries, and multiple ventricular septal defects. By classification and regression tree analysis, ventricular looping and visceroatrial situs were the greatest discriminators of conduction location. A total of 94 of 105 patients (89.5%) were free of complete heart block. Only 1 patient (2.9%) with heterotaxy syndrome developed complete heart block.
The precise anatomic location of the conduction system in patients with complex congenital heart defects can be difficult for the surgeon to accurately predict. Intraoperative conduction mapping enables localization of the His bundle and adds to our understanding of the anatomic factors associated with conduction location. Predictive modeling of conduction anatomy may build on what is already known about the conduction system and help surgeons to better anticipate conduction location preoperatively and intraoperatively.
本研究的目的是报告在复杂先天性心脏病手术中传导系统标测的经验不断增加，并创建传导解剖结构的预测模型。
对接受传导标测的复杂心脏修复患者进行研究。术中标测使用多电极导管在开放、减压、跳动的心脏中收集希氏束电图。分析患者的解剖结构、手术细节、希氏束位置和术后传导状态。通过使用分类和回归树分析，创建了传导位置的预测模型。
共有109例患者接受了标测。中位年龄和体重分别为1.8岁（范围0.2 - 14.9岁）和10.8千克（范围3.5 - 50.4千克）。96%（105/109）的患者成功识别出传导。中位标测时间为6分钟（范围2 - 33分钟）。解剖结构包括房室管缺损、右心室双出口、大动脉复杂转位和多个室间隔缺损。通过分类和回归树分析，心室襻和内脏心房位是传导位置的最大判别因素。105例患者中有94例（89.5%）无完全性心脏传导阻滞。只有1例（2.9%）患有心脏异构综合征的患者发生了完全性心脏传导阻滞。
对于外科医生来说，准确预测复杂先天性心脏缺陷患者传导系统的精确解剖位置可能具有挑战性。术中传导标测能够定位希氏束，并增进我们对与传导位置相关的解剖因素的理解。传导解剖结构的预测模型可以基于对传导系统的已有认识构建，帮助外科医生在术前和术中更好地预测传导位置。
