POSTOPERATIVE ARRHYTHMIAS: IDENTIFICATION AND MECHANISMS

术后心律失常：识别和机制

基本信息

批准号：
3342894
负责人：
VICTORIA L VETTER
金额：
$ 10.34万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
依托单位国家：
美国
项目类别：
财政年份：
1983
资助国家：
美国
起止时间：
1983-09-30 至 1993-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/3342894
关键词：
antiarrhythmic agent arrhythmia child (0-11) congenital heart disorder disease /disorder proneness /risk electrophysiology epicardial mapping heart disorder chemotherapy heart disorder diagnosis heart surgery human subject pediatric pharmacology postoperative state sudden cardiac death

项目摘要

Reparative surgery is available for most types of congenital heart defects. Many children who undergo open heart surgery develop postoperative arrhythmias that are sudden, unexpected and life threatening. The incidence of sudden death in patients who have had repairs of tetralogy of Fallot and transposition of the great arteries as well as other complex lesions exceeds 5%. The goals of this project will be to use the electrophysiologic study in these patients 1) to identify the specific types of rhythm disturbances present in patients with various forms of congenital heart disease; 2) to identify which electrophysiologic parameters in any specific group of patients may be used to identify those patients at high risk for developing serious arrhythmias; 3) to investigate and identify electrophysiologic mechanisms, of specific postoperative arrhythmias; 4) to determine effective drug regimens for specific arrhythmias by utilizing the electrophysiologic study; 5) to determine the effects of variations in operative techniques or types of operative repairs of specific congenital heart defects on the development of postoperative electrophysiologic abnormalities and arrhythmias; 6) to determine the effects of variations in timing of surgical repairs of specific congenital heart defects on the subsequent development of postoperative electrophysiologic abnormalities and arrhythmias. Specific areas to be investigated include the switch repair of transposition versus the Senning or Mustard, the early repair of tetralogy of Fallot versus later repair, and the Fontan repair. The current empiric approaches to postoperative arrhythmias have not decreased the incidence of sudden death. A greater understanding of these arrhythmias including a method to identify high risk patients, knowledge of mechanisms, and information regarding the electrophysiologic effects of therapy should provide a more rational and effective approach to the management of arrhythmias in these children. The electrophysiologic methods used in this study will include the use of programmed electrical stimulation to evaluate electrophysiologic function of the sinus and atrioventricular nodes as well as conduction and refractoriness in the atrium, atrioventricular node and ventricle. The vulnerability of the atria and ventricles to develop arrhythmias will be assessed using the stimulation techniques of rapid pacing and premature extrastimuli. Endocardial catheter mapping techniques will be used to assess conduction and activation within the atria and ventricles. Numerous electrophysiologic parameters will be carefully evaluated to determine the most likely mechanism responsible for spontaneous or induced arrhythmias. Electrophysiologic testing in conjunction with drug administration (both oral and intravenous) will be used to evaluate mechanisms as well as to determine effective antiarrhythmic regimens.

大多数类型的先天性心脏都可以进行修复手术缺陷。许多接受心脏手术的孩子术后心律失常，突然，意外和生命威胁。患者突然死亡的发生率修复了Fallot的四部曲和伟大的换位动脉以及其他复合病变超过5％。目标这个项目将是使用电生理研究这些患者1）确定节奏的特定类型各种形式的先天性患者存在障碍心脏病; 2）确定哪些电生理参数在任何特定的患者中，可以使用患有严重心律失常的高风险患者； 3）到调查和识别特定的电生理机制术后心律失常； 4）确定有效的药物方案通过利用电生理学研究，用于特定的心律不齐； 5）确定手术技术变化的影响或特定先天性心脏缺陷的手术维修类型术后电生理学的发展异常和心律不齐； 6）确定特定先天性手术维修时机的变化术后发展的心脏缺陷电生理异常和心律不齐。特定区域要研究的包括转置的开关修复相对于senning或芥末酱，早期修复了四部曲法洛与后来的维修和丰丹修复。术后心律不齐的当前经验方法具有没有降低猝死的发生率。更大了解这些心律不齐，包括一种识别的方法高风险患者，机制知识和信息关于治疗的电生理作用应提供一种更合理和有效的方法来管理这些孩子的心律不齐。使用的电生理方法在这项研究中，将包括使用编程电气刺激评估窦的电生理功能和房室的淋巴结以及传导和耐磨性在心房中，房屋节点和心室。这心房和心室的脆弱性发展心律不齐将使用快速起搏的刺激技术进行评估和过早的外部。心内膜导管映射技术将用于评估传导和激活中心和心室。许多电生理参数将仔细评估以确定最可能的机制负责自发或诱发心律不齐。电生理测试与药物管理（口腔和静脉内）将用于评估机制并确定有效的抗心律失常方案。