Postoperative left anterior hemiblock and right bundle branch block following repair of tetralogy of Fallot. Clinical and etiologic considerations.

Previous reports have indicated an incidence of right bundle branch block (RBBB) and left anterior hemiblock (LAH) pattern varying from 8-22% following corrective surgery in patients with tetralogy of Fallot. Among 207 patients with tetralogy of Fallot operated on at our institution, 8.7% developed an ECG pattern of RBBB and LAH. These patients were followed for 1-13 years (mean 6.2 years) for a total of 111 patient years. All patients are alive and none have had documented late atrioventricular dissociation, syncope, or other symptoms. Transient heart block was present in one patient in the immediate postoperative period but has not recurred. This group of patients differs significantly from other series in which such an ECG pattern was associated with a marked increase in morbidity and mortality. These data and the experimental evidence suggest that two distinct groups of patients exist: 1) a group in which this ECG pattern is secondary to lesions within the bundle of His and 2) a group in which the pattern is caused by lesions in the peripheral conduction system. It is postulated that these two groups which demonstrate the same ECG pattern may carry significantly different prognoses. Analysis of H-V intervals postoperatively may help identify patients at risk.