Günal N, Tokel K, Kahramanyol O, Ozer S, Celiker A, Ekici E, Yurdakul Y, Kutsal A
Pediatric Cardiology Unit, Ankara Social Insurance Hospital of Children, Turkey.
Turk J Pediatr. 1997 Oct-Dec;39(4):491-8.
Ventricular and supraventricular arrhythmias and conduction disturbances were evaluated by routine electrocardiography and 24-hour ambulatory monitoring in 31 patients who underwent correction of tetralogy of Fallot. The interval from operation to the study was 1 month to 14 years (mean 4.8 +/- 2.8). Complete right bundle branch block occurred in 22 (71%) patients and incomplete right bundle branch block in 9 (29%) patients. Bifascicular block with right bundle branch block and left axis deviation (LAD) occurred in one patient. Two patients had second degree type II atrioventricular block. Twenty-four-hour ambulatory electrocardiographic monitoring was performed in all patients and they were divided in two groups according to the frequency of ventricular arrhythmias (Lown classification). Group 1 included the 23 patients who had no arrhythmia or rare ventricular arrhythmias (Lown grade 0-1). Group 2 was comprised of eight patients (26%) with significant ventricular arrhythmias (Lown grade 2-5). Twelve patients (39%) had supraventricular arrhythmias, three patients rare supraventricular tachycardia attacks, and seven patients occasional supraventricular ectopies. One patient had bradycardia-tachycardia attacks and one patient had junctional tachycardia. There was no correlation between age at the time of surgery and ventricular arrhythmias. Of the patients who had ventricular and supraventricular arrhythmias of various degrees on ambulatory monitoring, two had significant arrhythmias on routine electrocardiogram. Symptoms were rare in these patients. In conclusion, both supraventricular and ventricular arrhythmias were found in considerable frequency in our patients. As ventricular arrhythmias may be the cause of sudden death and supraventricular arrhythmias are a main cause of morbidity, it is important to evaluate ventricular and supraventricular arrhythmias by ambulatory monitoring in patients who have undergone correction of tetralogy of Fallot.
通过常规心电图和24小时动态监测，对31例接受法洛四联症矫治术的患者的室性和室上性心律失常及传导障碍进行了评估。从手术到研究的时间间隔为1个月至14年（平均4.8±2.8年）。22例（71%）患者出现完全性右束支传导阻滞，9例（29%）患者出现不完全性右束支传导阻滞。1例患者出现右束支传导阻滞合并左前分支阻滞的双分支阻滞。2例患者出现二度II型房室传导阻滞。对所有患者进行了24小时动态心电图监测，并根据室性心律失常的频率（洛恩分类法）将他们分为两组。第1组包括23例无心律失常或罕见室性心律失常（洛恩分级0 - 1级）的患者。第2组由8例（26%）有显著室性心律失常（洛恩分级2 - 5级）的患者组成。12例（39%）患者出现室上性心律失常，3例患者有罕见的室上性心动过速发作，7例患者有偶发的室上性早搏。1例患者有心动过缓 - 心动过速发作，1例患者有交界性心动过速。手术时的年龄与室性心律失常之间无相关性。在动态监测中有不同程度室性和室上性心律失常的患者中，2例在常规心电图上有显著心律失常。这些患者症状罕见。总之，我们的患者中室上性和室性心律失常的发生率都相当高。由于室性心律失常可能是猝死的原因，而室上性心律失常是发病的主要原因，因此对接受法洛四联症矫治术的患者进行动态监测以评估室性和室上性心律失常非常重要。
