Predictors of rhythm disturbances and subsequent morbidity after the Fontan operation.
Predictors of rhythm disturbances and subsequent morbidity after the Fontan operation.
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Fontan 手术后节律紊乱和后续发病率的预测因子。
DOI：
10.1016/0002-9149(89)90761-3
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
Rosenfeld,LE
中科院分区：
文献类型：
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作者：
Weber,HS;Hellenbrand,WE;Kleinman,CS;Perlmutter,RA;Rosenfeld,LE
回顾性分析 1977 年至 1986 年间 30 名接受 Fontan 手术的患者的心电图、血流动力学和手术数据，以确定术后即刻和晚期心律失常的发生率和预测因素以及长期幸存者的相关发病率。术后 1 年内死亡的 4 例患者（死亡率 13%）中，1 例死亡与心律失常有关。三名患者在手术前未处于窦性心律，因此被排除在检查心律失常预测因素的统计分析之外。其余 23 名长期幸存者自手术后已随访 6.3 ± 2.6 年（平均值 ± 标准差），且全部仍处于纽约心脏协会 I 级或 II 级功能。 10 名患者 (43%) 出现术后即刻心律失常（≤ 30 天），而 11 名患者 (48%) 出现晚期心律失常。经过长达10.7年的随访，没有晚期心律失常的患者比例持续下降。心律失常包括缓慢性心律失常、房性快速性心律失常、快速-缓慢综合征和室上性异位活动。术后即刻心律失常预示着晚期心律失常（p = 0.022）。术前心电图是唯一可用于预测术后即刻和晚期心律失常的变量。 V1 导联中更负的 P 波偏转（-2.4 ± 0.7 vs -1.4 ± 1.2 mV，p = 0.02）可预测患者术后即刻心律失常，而该导联中更长的 P 波持续时间和更负的偏转可预测晚期心律失常（103 ± 14 vs 83 ± 20 ms，p = 0.01 和 -2.5 ± 0.8）与 −1.3 ±1.0 mV，p = 0.005，分别）。在 26 名幸存患者中，10 名（38%）需要 ≥1 次住院治疗以控制晚期心律失常。 8 名患者正在接受包括胺碘酮（1 名患者）在内的多种抗心律失常药物的维持治疗，5 名患者接受了永久性心外膜起搏器。因此，尽管 Fontan 手术后功能效果良好，但术后心律失常很频繁，并导致显着的发病率，并且随着时间的推移，发病率将继续增加。术前心电图的心房异常可预测患者在术后即刻和术后晚期会出现心律失常。术后立即出现心律失常也预示着晚期心律失常的后续发展。对这些预测因素的识别可能有助于此类患者的监测和治疗。
The electrocardiographic, hemodynamic and surgical data of 30 patients who underwent a Fontan operation between 1977 and 1986 were retrospectively reviewed to identify the incidence and predictors of immediate and late postoperative arrhythmias and associated morbidity in long-term survivors. Of 4 patients who died <1 year after operation (mortality 13%), 1 death was related to an arrhythmia. Three patients were not in sinus rhythm before operation and were excluded from the statistical analysis that examined predictors of arrhythmias. The remaining 23 long-term survivors have been followed 6.3 ± 2.6 years (mean ± standard deviation) since surgery and all remain in New York Heart Association functional class I or II. Ten patients (43%) developed immediate postoperative arrhythmias (≤ 30 days) whereas 11 (48%) had late arrhythmias. With up to 10.7 years of followup, the proportion of patients free from late arrhythmias continues to decline. Arrhythmias included bradyarrhythmias, atrial tachyarrhythmias, the tachy-brady syndrome and supraventricular ectopic activity. Immediate postoperative arrhythmias predicted late arrhythmias (p = 0.022). The preoperative electrocardiogram was the only variable useful in predicting both immediate and late postoperative arrhythmias. A more negative P-wave deflection in lead V1(-2.4 ± 0.7 vs -1.4 ± 1.2 mV, p = 0.02) predicted patients with immediate postoperative arrhythmias, whereas both greater P-wave duration and a more negative deflection in this lead predicted late arrhythmias (103 ± 14 vs 83 ± 20 ms, p = 0.01, and -2.5 ± 0.8 vs −1.3 ±1.0 mV, p = 0.005, respectively). Of the 26 surviving patients, 10 (38%) have required ≥1 hospitalizations for control of late arrhythmias. Eight patients are receiving maintenance therapy with multiple antiarrhythmic drugs including amiodarone (1 patient) and 5 have received permanent epicardial pacemakers. Thus, despite excellent functional results after the Fontan operation, postoperative arrhythmias are frequent and cause significant morbidity that will continue to increase with time. Atrial abnormalities on the preoperative electrocardiogram predict those patients who will develop arrhythmias both in the immediate and late postoperative periods. The appearance of an immediate postoperative arrhythmia also predicts the subsequent development of late arrhythmias. Recognition of these predictors may facilitate monitoring and therapy of such patients.