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Surgical bifascicular block.

D B Pahlajani, M Serratto, A Mehta

    Circulation
    |July 1, 1975
    PubMed
    Summary

    Electrophysiological studies in patients after VSD or TF repair revealed conduction abnormalities in seven cases. However, long-term outcomes were benign, suggesting prophylactic pacemakers are not indicated.

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    Area of Science:

    • Cardiology
    • Cardiac Electrophysiology
    • Congenital Heart Disease Surgery

    Background:

    • Bifascicular block can occur after surgical repair of ventricular septal defect (VSD) and tetralogy of Fallot (TF).
    • Understanding the electrophysiological consequences of these repairs is crucial for patient management.

    Purpose of the Study:

    • To investigate electrophysiological abnormalities in patients with bifascicular block post-VSD or TF repair.
    • To assess the long-term clinical course and determine the need for prophylactic pacemakers.

    Main Methods:

    • Electrophysiological studies including interval recordings (P-A, A-H, H-V) and atrial pacing.
    • Measurement of effective and functional refractory periods (ERP, FRP) of the atrium, A-V node, and ventricular conduction system.
    • Long-term clinical follow-up of patients.

    Main Results:

    • Seven out of 18 patients exhibited abnormalities in the A-V node and/or His-Purkinje system.
    • Prolonged A-H and H-V intervals were observed in some patients.
    • Two patients experienced transient complete heart block (CHB) postoperatively; two developed type II block during pacing.

    Conclusions:

    • Electrophysiological assessment is vital for detecting all conduction abnormalities after VSD/TF repair.
    • Despite electrophysiological findings, patients demonstrated a benign clinical course with intact conduction long-term.
    • Prophylactic demand pacemaker insertion is not typically indicated in this patient cohort.

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