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Arrhythmic complications of surgically corrected congenital cardiac defects

机译:手术矫正先天性心脏缺陷的心律失常并发症

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Over the past 50 years, cardiac surgery has dramatically modified the natural history of congenital heart defects in such a way that a high proportion of babies born with a heart defect will survive to adulthood. Early and late postoperative arrhythmias, however, are a major cause of morbidity and mortality in this growing population. In the immediate postoperative period, heart block still complicates 1-3 % of surgeries and a pacemaker is required if the block persists beyond 10 days. Sinus node dysfunction is not uncommon in palliated univentricular hearts. Tachycardias are even more common than bradycardias and may occur early or late after a cardiac repair. Junctional ectopic tachycardia is common and potentially fatal but may well be controlled and treated if recognised early and treated aggressively (amiodarone is the cornerstone of therapy). Late atrial and ventricular tachycardias may modify significantly the patient's quality and duration of life. Intra-atrial re-entrant tachycardia affects a high proportion of patients operated on for transposition of the great arteries at the atrial level or for any palliation of univentricular hearts. Radiofrequency catheter ablation using new three-dimensional mapping and irrigated catheter technologies offers an interesting alternative to medical therapy and diminishes needs for complex surgical reinterventions. Ventricular tachycardia is the main cause of sudden death in adults with operated tetralogy of Fallot.
机译:在过去的50年中,心脏外科手术极大地改变了先天性心脏缺陷的自然病史,从而使大部分患有心脏缺陷的婴儿能够存活到成年。然而,术后早期和晚期心律不齐是该不断增长的人口发病率和死亡率的主要原因。在术后即刻,心脏传导阻滞仍然使1-3%的手术复杂化,如果心脏传导阻滞持续超过10天,则需要起搏器。窦房结功能异常在苍白的单心室心脏中并不罕见。心动过速甚至比心动过缓更常见,并且可能在心脏修复后的早期或晚期发生。交界性异位性心动过速很常见,可能致命,但如果及早发现并积极治疗,则可以很好地控制和治疗(胺碘酮是治疗的基石)。晚期房性和室性心动过速可能会显着改变患者的质量和生命周期。房内折返性心动过速会影响接受手术的患者中很大一部分,这些患者在心房水平上发生大动脉移位或对单心室心脏进行任何缓解。使用新的三维测绘和灌溉导管技术的射频导管消融为药物治疗提供了一种有趣的替代方法,并减少了对复杂外科手术的需求。患有法洛四联症的成年人,室性心动过速是猝死的主要原因。

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