Long-term management of bradyarrhythmias following open heart surgery: Surgical A-V block and sick sinus syndrome after surgery for secundum atrial septal defects treated with permanent cardiac pacing.
スポンサーリンク
概要
- 論文の詳細を見る
Postoperative clinical findings from 25 patients with surgical A-V block and 12 with SSS following surgery for ASD who received permanent pacemakers were analyzed in order to consider the long-term management of postoperative bradyarrhythmias. (1) Surgical A-V block : Episodes of Adams-Stokes were observed in 11/25 patients before pacemaker implantation, and in 6 of these (55%) the onset of episodes occurred more than a year after open heart surgery. Of 8 cases for which ECG's during Adams-Stokes were available, 2 had bifascicular or trifascicular block which progressed to complete A-V block below the His bundle. The 6 others (75%) had ventricular tachycardia or ventricular flutter-fibrillation during Adams-Stokes. 2 of these had blocks above the His bundle. 4/25 had improvement of complete A-V block within a month. Following pacemaker implantation, 3 died of heart failure and 3 of sudden death. 5 year survival was 70%. Therefore, surgical A-V block requires careful long-term management, and the presence of ventricular tachyarrhythmias as well as the location of block are important predictors of patient risk. (2) SSS after surgery for ASD : 10/12 patients had Adams-Stokes, of which 6 (60%) had initial onset over 5 years after surgery, and 9 had paroxysmal atrial flutter and fibrillation which coincided with the onset of Adams-Stokes. 3 of 7 patients (42%) for whom preoperative ECG's were available had sinus bradycardia. Thus, SSS after ASD surgery maybe preceded by preoperative deterioration of sinus node function and succeeded by late onset of Adams-Stokes, necessitating pre- and postoperative assessment of sinus node function. The presence of atrial tachyarrhythmias also serves as an important indicator of the severity of SSS after ASD surgery. The onset of Adams-Stokes varied by patient over a wide range of time, emphasizing the need for careful long-term follow-up. Clinical symptoms and prognosis were affected by tachyarrhythmias as well as the severity of the bradycardia. Therefore, the presence of ventricular/atrial tachyarrhythmias is an important factor in the long-term management of postoperative bradyarrhythmias.
- 社団法人 日本循環器学会の論文
社団法人 日本循環器学会 | 論文
- ANTIARRHYTHMIC AND MYOCARDIAL METABOLIC EFFEDTS OF VERAPAMIL DURING CORONARY ARTERY REPERFUSION
- EFFECTS OF PROPRANOLOL AND DILTIAZEM ON THE RATE OF HIGH-ENERGY PHOSPHATE METABOLISM IN REPERFUSED RAT HEARTS
- SIMULTANEOUS DUAL MYOCARDIAL IMAGING WITH IODINE-123-β-METHYL IODOPHENYL-PENTADECANOIC ACID (BMIPP) AND THALLIUM-201 IN PATIENTS WITH CORONARY HEART DISEASE
- EFFECTS OF L-CARNITINE ON VENTRICULAR ARRHYTHMIAS IN DOGS WITH ACUTE MYOCARDIAL ISCHEMIA AND A SUPPLEMENT OF EXCESS FREE FATTY ACIDS
- EFFECTS OF L-CARNITINE ON TISSUE LEVELS OF ACYL CARNITINE, ACYL COENZYME A AND HIGH ENERGY PHOSPHATE IN ISCHEMIC DOG HEARTS