POSTOPERATIVE ARRHYTHMIAS: IDENTIFICATION AND MECHANISMS

修复性手术适用于大多数类型的先天性心脏病 缺陷。许多接受心内直视手术的儿童 术后心律失常是突然的、意想不到的和生命的 具有威胁性。慢性阻塞性肺疾病患者猝死的发生率 法洛四联症修复术和大腿移位术 动脉以及其他复杂病变超过5%。目标 该项目的主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来识别 患严重心律失常的高危患者；3) 研究和确定特定的电生理机制 术后心律失常；4)确定有效用药方案 针对特殊心律失常，利用电生理学研究； 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修复类型 浅谈术后电生理学的发展 异常和心律失常；6)确定 特定先天畸形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。特定领域 有待研究的内容包括换位开关的维修 与森宁或芥末相比，早期修复的四联症 法洛特与后来的修复，以及方坦的修复。 目前治疗术后心律失常的经验性方法有 未降低猝死发生率。一个更伟大的 对这些心律失常的理解，包括一种识别方法 高危患者、机制知识和信息 关于治疗的电生理效应应该提供 更合理、更有效的管理方法 这些儿童的心律失常。所使用的电生理学方法 在这项研究中将包括程序电气的使用 刺激评价窦房结的电生理功能 房室结以及传导和不应期 在心房、房室结和脑室。这个 房室易患心律失常 将使用快速起搏的刺激技术进行评估 和过早的超前刺激。心内膜导管标测 将使用技术来评估内部传导和激活 心房和脑室。众多电生理参数 将被仔细评估以确定最有可能的机制 对自发性或诱发性心律失常负责。 电生理检查与给药 (口服和静脉注射)将用于评估机制，如 以及确定有效的抗心律失常方案。

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.