Background

Postoperative atrioventricular block requiring pacemaker (AVB/PM) complicates 14% to 25% of biventricular repair operations for complex congenital heart disease (CHD) and in those with heterotaxy syndrome.

Objectives

This study aimed to evaluate if intraoperative His bundle (HB) mapping during complex biventricular CHD repair can be performed safely and reduce postoperative AVB/PM.

Methods

HB mapping was performed using a commercially available multielectrode grid catheter in patients with complex CHD undergoing biventricular repair between 2019 and 2022 compared with an unmapped cohort. The primary outcome was postoperative AVB/PM.

Results

One hundred forty-nine patients underwent HB mapping compared to 201 unmapped controls. The median age of mapped patients was 1.9 years (Q1-Q3: 0.9-3.9 years). Heterotaxy syndrome was present in 31% (n = 46 of 149), ventricular septal defect in 95% (n = 142 of 149), and prior single ventricle palliation in 68% (n = 89 of 149). The HB was identified in 97% (n = 144 of 149) of cases. The median mapping time was 6 minutes. No episodes of intraoperative systemic air embolism occurred. Postoperative AVB/PM frequency was significantly reduced in mapped patients with heterotaxy (2% [n = 1 of 46] vs 16% [n = 11 of 67]; P = 0.026) and in patients without L-malposed great arteries (3% [n = 3 of 88] vs 11% [n = 15 of 134]; P = 0.045).

Conclusions

Intraoperative HB mapping can be performed safely and is associated with significantly reduced postoperative AVB/PM in select populations undergoing complex biventricular repair, including heterotaxy syndrome and non–L-malposed great arteries. Nonetheless, certain subgroups remain at risk for AVB/PM, showing the need for further improvements to current intraoperative HB mapping technology and techniques.

中文翻译：

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术中传导标测减少复杂性先天性心脏病术后房室传导阻滞

 背景

术后需要起搏器的房室传导阻滞 （AVB/PM） 使 14% 至 25% 的复杂先天性心脏病 （CHD） 和异位综合征患者的双心室修复手术复杂化。

 目标

本研究旨在评估复杂双心室 CHD 修复术中 His 束 （HB） 标测是否可以安全地进行并减少术后 AVB/PM。

 方法

与未标测队列相比，在 2019 年至 2022 年期间接受双心室修复的复杂 CHD 患者中使用市售的多电极网格导管进行 HB 标测。主要结局是术后 AVB/PM。

 结果

149 例患者接受了 HB 标测，而 201 例未标测对照组。标测患者的中位年龄为 1.9 岁 （Q1-Q3： 0.9-3.9 岁）。31% 的患者存在异位综合征 （149 例中的 n = 46 例），95% 的患者存在室间隔缺损 （149 例中的 n = 142 例），68% 的患者既往接受过单心室姑息治疗 （149 例中的 n = 89 例）。在 97% 的病例 （149 例中的 n = 144） 中鉴定出 HB。中位标测时间为 6 分钟。术中未发生全身性空气栓塞发作。标测异位患者的术后 AVB/PM 频率显著降低 （2% [n = 1/46] 对 16% [n = 11/67];P = 0.026）和无 L 病态大动脉的患者 （3% [n = 3/88] vs 11% [n = 15/134];P = 0.045）。

 结论

术中 HB 标测可以安全地进行，并且与接受复杂双心室修复的特定人群的术后 AVB/PM 显着降低有关，包括异位综合征和非 L 畸形大动脉。尽管如此，某些亚组仍存在 AVB/PM 的风险，表明需要进一步改进当前的术中 HB 标测技术和技巧。