法洛四联症根治术后远期心律失常的随访

Arrhythmia in the long-term follow-up after intracardiac repair of tetralogy of Fallot

目的 了解法洛四联症 (TOF)根治术后远期心律失常的发生率以及影响心律失常发生的相关因素。方法 54例法洛四联症根治术后患儿 ,男 3 5例 ,女 19例 ;年龄 5～ 14岁 [( 9 4± 2 5)岁 ]。术时年龄 17个月～ 117个月 ,随访年限 2 8～ 9 0年。进行了心电图、2 4小时Holter、二维超声心动图和活动平板运动试验检查。结果 18例患儿存在不同程度的室性心律失常 ,室性心律失常的发生率为 3 3 % ,其中 1例患儿有短阵室性心动过速发生。 4例右室收缩压增高者均存在明显室性心律失常 ,右室收缩压正常者室性心律失常发生率为 2 8% ( 14 / 50例 ) ,两者差异有显著性 (P =0 0 1)。体外循环时间≥ 90min者室性心律失常发生率为 53 % ( 10 / 19例 ) ,体外循环时间 <90min的患儿室性心律失常发生率为 2 3 % ( 8/ 3 5例 ) ,两者差异有显著性 (P <0 0 5)。轻度肺动脉瓣返流组室性心律失常发生率为 2 1% ( 4 / 19例 ) ,中、重度肺动脉瓣返流组室性心律失常的发生率为 40 % ( 14 / 3 5例 ) ,两组差异无显著性 ( χ2 =1 989,P >0 0 5)。随访年限 5年以内室性心律失常发生率为 3 2 % ( 8/ 2 5例 ) ,5年以上患儿的室性心律失常发生率为 3 4 % ( 10 / 2 9例 ) ,两者差异无显著性 ( χ2 =0 0 3 7,P >0 0 5)。手术年龄?

Objective The long-term success of intracardiac repair of tetralogy of Fallot is hampered by the occurrence of arrhythmias The aim of the present study was to determine the incidence of arrhythmias after intracardiac repair of tetralogy of Fallot and their correlation with surgical and clinical findings Methods The study group consisted of 54 patients, 35 males and 19 females They underwent repair at a mean age of 51 months (range 17 to 117 months) The median age at the time of study was 9 4 years (range 5 to 14 years), and the mean duration of follow-up was 4 3 years (range 2 8 to 9 0 years) after surgery The follow-up study included routine ECG, 24 hour Holter, echocardiography and exercise testing Results The incidence of ventricular arrhythmia was 33 percent, and 1 patient had non-sustained ventricular tachycardia All patients with elevated right ventricular pressure had ventricular arrhythmias, and 28% of patients with normal right ventricular pressure had ventricular arrhythmias (P<0 05) 53% of patients had significant ventricular arrhythmias when the duration of cardiopulmonary bypass was ≥90 minutes, as opposed to 23% when it was <90 minutes (P<0 05) There was no significant difference in prevalence of ventricular arrhythmias between mild pulmonary regurgitation and severe pulmonary regurgitation (21% vs 40%,P>0 05) No significant difference was found in the incidence of ventricular arrhythmias between follow-up in five years and more than five years (32% vs 34%,P>0 05) Age at surgery correlated with the prevalence of ventricular arrhythmias (r=-0 221, P<0 05) Eight patients (15%) had supraventricular arrhythmias Conclusion The frequency of ventricular arrhythmias correlated with elevated right ventricular systolic pressure, the duration of cardiopulmonary bypass, and the age at surgery No correlation was found between pulmonary regurgitation and the duration of follow-up Exercise-induced frequent multiform premature ventricular complexes were associated with abnormal hemodynamic status and high risk of ventricular tachycardia