Pastore J O, Yurchak P M, Janis K M, Murphy J D, Zir L M
Circulation. 1978 Apr;57(4):677-80. doi: 10.1161/01.cir.57.4.677.
The risk of advanced atrioventricular block during anesthesia was studied prosepctively in 44 patients with right bundle branch block and left axis deviation who underwent a total of 52 operations over a 14 month period. All patients had continuous electrocardiographic monitoring throughout anesthesia induction, operation, and surgical recovery. Of the 52 operative procedures, 24 were done under general anesthesia, 11 under spinal, and 17 under local. The preoperative cardiac rhythms were atrial fibrillation in two patients, atrial tachycardia with block in one patient, atrial flutter in one patient, and sinus rhythm in the remaining patients. Temporary pacemakers were inserted preoperatively in six patients, usually because of PR interval prolongation on the preoperative electrocardiogram. There was only one episode of transient complete heart block in 51 of the 52 operative procedures. In two of the six patients with temporary pacemakers, significant pacer-related ventricular irritability occurred. This study indicates that temporary pacemaker insertion is rarely required in patients with chronic right bundle branch block and left axis deviation who require noncardiac surgery.
在14个月的时间里，对44例右束支传导阻滞合并左轴偏移的患者进行了前瞻性研究，这些患者共接受了52例手术，研究了麻醉期间发生高度房室传导阻滞的风险。所有患者在麻醉诱导、手术及术后恢复期间均进行连续心电图监测。52例手术中，24例在全身麻醉下进行，11例在脊髓麻醉下进行，17例在局部麻醉下进行。术前心律方面，2例患者为心房颤动，1例患者为心房扑动伴阻滞，1例患者为心房扑动，其余患者为窦性心律。6例患者术前植入了临时起搏器，通常是因为术前心电图显示PR间期延长。在52例手术中的51例中仅发生了1次短暂性完全性心脏传导阻滞。在6例植入临时起搏器的患者中，有2例出现了与起搏器相关的明显心室易激惹。这项研究表明，对于需要进行非心脏手术的慢性右束支传导阻滞合并左轴偏移患者，很少需要植入临时起搏器。
