Neches W H, Park S C, Mathews R A, Lenox C C, Marin-Garcia J, Zuberbuhler J R
Circulation. 1977 Nov;56(5):713-9. doi: 10.1161/01.cir.56.5.713.
Electrophysiologic studies performed during postoperative cardiac catheterization in 51 patients following repair of tetralogy of Fallot (TF) were compared with studies performed in a control group of 30 patients. These studies include His bundle electrograms, measurement of atrioventricular (A-V) conduction at progressively increasing atrial pacing rates, and evaluation of sinus node recovery time. More postoperative TF patients (20%) had prolonged H-V intervals compared to the controls (7%). With atrial pacing, no patient in the control group developed second degree A-V block below 160 beats/min, while 23% of the postoperative TF patients developed block below this level. Half of these patients had normal His bundle studies. Stress of the A-V conduction system by atrial pacing may unmask conduction abnormalities not present on the surface electrocardiogram or on His bundle electrogram. Two-thirds of the patients had some form of conduction abnormality on the basis of evaluation of one or more parameters but about half of the patients with a given abnormality had normal findings in other areas. The high incidence of electrophysiologic abnormalities following TF repair may have future prognostic significance. Systematic evaluation of atrioventricular conduction during preoperative and postoperative cardiac catheterization may be of value.
对51例法洛四联症（TF）修复术后患者进行术后心导管检查时进行的电生理研究，与30例对照组患者的研究进行了比较。这些研究包括希氏束电图、在逐渐增加心房起搏频率时测量房室（A-V）传导，以及评估窦房结恢复时间。与对照组（7%）相比，更多的术后TF患者（20%）有H-V间期延长。在心房起搏时，对照组中没有患者在心率低于160次/分钟时发生二度A-V阻滞，而23%的术后TF患者在该水平以下发生阻滞。这些患者中有一半希氏束检查正常。心房起搏对A-V传导系统的应激可能会揭示体表心电图或希氏束电图上不存在的传导异常。根据一项或多项参数评估，三分之二的患者有某种形式的传导异常，但约一半有特定异常的患者在其他方面检查结果正常。TF修复术后电生理异常的高发生率可能具有未来的预后意义。术前和术后心导管检查期间对房室传导进行系统评估可能有价值。
