POSTOPERATIVE ARRHYTHMIAS: IDENTIFICATION AND MECHANISMS

大多数类型的先天性心脏病都可以进行修复手术 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，非预期的和生活 威胁。 在有以下症状的患者中猝死的发生率 法洛四联症和大动脉转位的修复术 动脉以及其他复杂病变超过5%。 的目标 该项目的一个重要目的是将电生理学研究用于 这些患者1）识别特定类型的节律 各种形式的先天性心脏病患者存在的障碍 心脏病; 2）确定哪些电生理参数 在任何特定的患者组中，可以用于识别那些 发生严重心律失常的高风险患者; 3） 研究和确定电生理机制， 术后心律失常; 4）确定有效的药物治疗方案 利用电生理学研究确定特定心律失常; 5)以确定手术技术变化的影响 或特定先天性心脏缺陷的手术修复类型 术后电生理的发展 异常和心律失常; 6）确定 特定先天性心脏病手术修复时机的变化 心脏缺陷对术后后续发展的影响 电生理异常和心律失常。 具体领域 要调查的包括换位的开关修理 相对于Senning或Mustard，早期修复的四联症， 法洛与后期修复术，以及丰坦修复术。 目前，术后心律失常的经验性方法有 并没有降低猝死的发生率。 更大 了解这些心律失常，包括识别 高风险患者、机制知识和信息 关于治疗的电生理效应， 更合理有效地管理 这些孩子的心律失常。 使用的电生理方法 在这项研究中，将包括使用程序化的电气 刺激以评价窦的电生理功能 房室结以及传导和不应性 心房房室结和心室 的 心房和心室易发生心律失常 将使用快速起搏的刺激技术进行评估 和过早的额外刺激 血管内导管标测 技术将被用来评估传导和激活内 心房和心室 许多电生理参数 将仔细评估，以确定最有可能的机制 导致自发性或诱发性心律失常。 电生理检查与药物给药联合 (both口服和静脉内）将用于评价机制， 以及确定有效的抗疟疾方案。

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.