Circulation, Vol 52, 82-87, Copyright © 1975 by American Heart Association
DB Pahlajani, M Serratto, A Mehta, RA Miller, A Hastreiter and KM Rosen
Electrophysiological studies were performed in 18 patients who developed
bifascicular block after repair of ventricular septal defect (VSD) or
tetralogy of Fallot (TF). Two had transient complete heart block (CHB) in
the immediate postoperative period. The P-A intervals were normal in all.
A-H and H-V intervals were prolonged in three and four cases, respectively.
Atrial pacing at progressively increasing heart rates was performed in 15
patients; two developed type II block distal to the His bundle (H). The
effective and functional refractory periods (ERP and FRP) of the atrium (11
cases) were normal in all. The ERP of the A-V node (seven cases) was
prolonged in found and the FRP was increased in three. The ERP of the
ventricular specialized conduction system was measured in two cases and was
prolonged in one. In all, seven cases had abnormalities indicating disease
of the A-V node and/or His-Purkinje system. Recording of intervals, atrial
pacing, and determination of refractory periods (RPs) was necessary to
reveal all conduction abnormalities. One patient died of unrelated causes.
The others are alive and in sinus rhythm with intact conduction 3 to 16.5
years following surgery (mean follow-up of 8.3 plus or minus 0.95 years).
The clinical course in patients with normal and abnormal findings was
equally benign. Prophylactic insertion of demand pacemakers does not appear
indicated in these patients.
ARTICLES
Surgical bifascicular block
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