Niimura I, Shibata T, Haraguchi T, Miyazawa Y, Kondo J, Sato S, Matsumoto A
Jpn Circ J. 1981 Feb;45(2):268-76. doi: 10.1253/jcj.45.268.
The incidence of arrhythmias in 3614 preoperative patients with congenital heart disease was 1.6 per cent. Pre- and postoperative serial ECGs in 186 patients with an isolated VSD and in 58 patients with TOF were reviewed. The incidence of CRBBB and CRBBB-LAH following VSD repair was 33% and 6.6%, respectively, and for TOF was 55% and 5.2%, respectively. Complete A-V block (CAVB) was seen in 2 patients following VSD repair, and none of TOF patients developed CAVB. Late cardiac or dysrrhythmic death was not recognized in our limited follow up period. The indications for surgery in membranous VSD should be determined more carefully, because the risk of the surgical damage to the conduction system is still higher. Moreover, we must keep in mind that damage to the A-V conduction system may occur naturally even in a patient with small VSD. Finally, it can never be overemphasized that physicians must pay attention to the occurrence and course of postoperative arrhythmias.
3614例先天性心脏病术前患者的心律失常发生率为1.6%。回顾了186例单纯室间隔缺损（VSD）患者和58例法洛四联症（TOF）患者术前及术后的系列心电图。VSD修复术后完全性右束支传导阻滞（CRBBB）和CRBBB伴左前分支阻滞（CRBBB-LAH）的发生率分别为33%和6.6%，TOF患者分别为55%和5.2%。VSD修复术后有2例患者出现完全性房室传导阻滞（CAVB），TOF患者均未发生CAVB。在我们有限的随访期内，未发现晚期心脏或心律失常死亡。膜周部VSD的手术适应证应更谨慎地确定，因为手术损伤传导系统的风险仍然较高。此外，我们必须牢记，即使是小VSD患者，房室传导系统也可能自然发生损伤。最后，医生必须关注术后心律失常的发生和过程，这一点无论如何强调都不为过。
