Document Detail


Postoperative ventricular arrhythmias after cardiac surgery: immediate- and long-term significance.
MedLine Citation:
PMID:  12710323     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AF is frequent after cardiac surgery. However, ventricular arrhythmias are less known. The purpose of the study was to evaluate the causes and the prognostic significance of severe ventricular arrhythmias occurring after cardiac surgery. For 10 years, among 2,100 cardiac surgeries, 16 (0.8%) patients (13 men, 3 women; age 49-71 years, mean 62 +/- 9 years) without previous ventricular arrhythmias, with preserved left ventricular ejection fraction, and without acute cause of ventricular arrhythmias, developed VF (n = 4) or a sustained VT between 3 days and 3 weeks after cardiac surgery (coronary artery bypass grafting [n = 6], valve replacement [n = 10]). Rapid AF (n = 5) or slow AF (n = 1) were present at the time of VT/VF. Programmed ventricular stimulation occurred after up to three extrastimuli in the basal state and after infusion of 20-30 micrograms of isoproterenol. An echocardiogram, coronary angiography, Holter monitoring with heart rate variability (HRV) study were performed. Ventricular stimulation was negative in six patients (with AF); sustained and clinical VT was induced in 10 patients with a left ventricular ejection fraction > 0.40, except in one patient. Valvular prothesis and coronary bypass graftings were normal. In all patients, HRV was normal before surgery and decreased after cardiac surgery; before versus after surgery, respectively, HR 69 +/- 9 and 89 +/- 30 beats/min (P < 0.01), SDNN 117 +/- 31 and 50 +/- 11 ms (P < 0.001), low frequency (LF) 474 +/- 658 and 51 +/- 40 ms2 (P < 0.05), high frequency (HF) 115 +/- 23 and 33 +/- 32 ms2 (P < 0.05), LF:HF 4 +/- 3 and 1 +/- 0.6 (P < 0.01). Follow-up lasted from 6 months to 10 years (mean 3 +/- 2 years). In patients without induced VT, 1 patient died from asystole, 1 had an ICD but no subsequent events, and the other 4 untreated patients are free of events. Patients with induced VT were treated with amiodarone and beta-blockers except in one patient who died from extracardiac complications. Six of nine patients had no inducible VT with this treatment and are alive; 3 patients had inducible VT, 1 died suddenly before implantation of ICD, and 2 patients are alive with an ICD; recurrent VTs were noted in one patient and received an ICD. In conclusion, recent heart surgery may increase the risk of ventricular arrhythmias. The reduction of indexes reflecting sympathetic and parasympathetic tone could facilitate the occurrence of atrial arrhythmias (and then VT) in patients without ventricular arrhythmogenic substrate or the development of VT/VF in patients with a latent previous ventricular arrhythmogenic substrate. In patients without inducible VT, the prognosis is excellent and an ICD is not recommended in these patients. In those with inducible VT, there is a high incidence of responders to antiarrhythmic drugs with a favorable prognosis.
Authors:
Béatrice Brembilla-Perrot; Jean-Pierre Villemot; Jean-Pierre Carteaux; Annick Haouzi; Danièle Amrein; Bruno Schöth; Pierre Houriez; Daniel Beurrier; Karim Djaballah; Anne Claire Vançon; Marc Nippert
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  26     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-04-24     Completed Date:  2003-07-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  619-25     Citation Subset:  IM    
Affiliation:
Department of Cardiology, CHU of Brabois, Vandoeuvre, France. b.brembilla-perrot@chu-nancy.fr
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MeSH Terms
Descriptor/Qualifier:
Anti-Arrhythmia Agents / therapeutic use
Defibrillators, Implantable
Electrocardiography
Electrophysiologic Techniques, Cardiac
Female
Follow-Up Studies
Heart Diseases / surgery*
Heart Rate / physiology
Humans
Male
Middle Aged
Postoperative Complications / epidemiology*,  therapy
Prognosis
Stroke Volume
Tachycardia, Ventricular / epidemiology*,  etiology,  therapy
Time Factors
Ventricular Fibrillation / epidemiology*,  etiology,  therapy
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents

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