POSTOPERATIVE ARRHYTHMIAS: IDENTIFICATION AND MECHANISM

大多数类型的先天性心脏病都可以进行矫正手术 缺陷 许多接受心脏直视手术的儿童 术后心律失常是突然的，意外的， 危及生命 有过心脏病史的患者中猝死的发生率 法洛四联症和大动脉转位修复术 超过5%。 本研究的目的是使用电生理学 在这些患者中进行研究，以1）确定特定类型的节律 与特定病变相关的干扰，2）识别 电生理因素可用于识别高危患者 发生严重心律失常，3）调查和确定 特定术后心律失常的电生理机制，以及4） 制定一个逻辑和有效的方法来选择一个具体的 通过确定电生理效应的抗心律失常方案， 药物对儿童特定心律失常的有效性。 当前 术后心律失常的经验性方法并没有减少 猝死的发生率。 希望能更好地了解 这些心律失常的发展，包括使用客观方法 识别高风险患者，沿着机制知识， 关于电生理效应的客观信息， 具体治疗将提供更合理和有效的方法 治疗这些孩子的心律失常 的电生理 在这项研究中使用的方法将包括使用编程的电 刺激以评价窦和AV的电生理功能 节点以及心房、AV节点和 脑室 心房和心室的脆弱性， 心律失常将使用快速刺激技术进行评估， 起搏和过早刺激 内镜导管标测技术 将用于评估心房内的传导和激活， 心室 许多电生理参数将仔细 评估以确定最可能的机制， 自发性或诱发性心律失常。 电生理测试 与药物给药（口服和静脉内）联合使用， 用于评估机制以及确定有效的 抗疟疾方案。

Corrective 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 exceeds 5%. The goals of this study will be to use the electrophysiologic study in these patients to 1) identify the specific types of rhythm disturbances associated with a particular lesion, 2) identify which electrophysiologic factors may be used to identify patients at high risk for developing serious arrhythmias, 3) to investigate and identify the electrophysiologic mechanisms of specific postoperative arrhythmias, and 4) to develop a logical and effective approach to the choice of a specific antiarrhythmic regimen by determining the electrophysiologic effects and effectiveness of drugs on specific arrhythmias in children. The current empiric approaches to postoperative arrhythmias have not decreased the incidence of sudden death. It is hoped that a greater understanding of the development of these arrhythmias including the use of an objective method to identify high risk patients, along with knowledge of mechanisms and objective information regarding the electrophysiologic effects of a specific therapy would provide for 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 AV nodes as well as conduction and refactoriness in the atrium, AV 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.