Perioperative Ventricular Dysrhythmias in Patients with Structural Heart Disease Undergoing Noncardiac Surgery

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Conduction disturbances, such as right bundle-branch block or first-degree atrioventricular block, may lead to concern but usually do not justify further workup. The same is often true of asymptomatic ventricular arrhythmias, even in the presence of structural heart disease (36,37). On the other hand, subtle ECG clues can point to a clinically silent condition of major importance.…”

“…Both supraventricular and ventricular arrhythmias have been identified as independent risk factors for coronary events in the perioperative period (17,114). More recent detailed studies using continuous ECG monitoring found that asymptomatic ventricular arrhythmias, including couplets and nonsustained ventricular tachycardia, were not associated with an increase in cardiac complications after noncardiac surgery (37). Nevertheless, the presence of an arrhythmia in the preoperative setting should provoke a search for underlying cardiopulmonary disease, ongoing myocardial ischemia or infarction, drug toxicity, or metabolic derangements.…”

“…Ventricular arrhythmias, whether single premature ventricular contractions, complex ventricular ectopy, or nonsustained ventricular tachycardia, usually do not require therapy unless they result in hemodynamic compromise. Although frequent ventricular premature beats and nonsustained ventricular tachycardia are considered risk factors for the development of intraoperative and postoperative arrhythmias and sustained ventricular arrhythmias during longterm follow-up, they are not associated with an increased risk of nonfatal MI or cardiac death in the perioperative period (36,37). However, patients who develop sustained and/or nonsustained ventricular tachycardia during the perioperative period should be referred to a cardiologist for further evaluation, including an evaluation of their ventricular function and screening for CAD.…”

“…Studies have shown that although nearly half of all high-risk patients undergoing noncardiac surgery have frequent premature ventricular contractions or asymptomatic nonsustained ventricular tachycardia, the presence of these ventricular arrhythmias is not associated with an increase in nonfatal MI or cardiac death (36,37). Nevertheless, the presence of an arrhythmia in the preoperative setting should provoke a search for underlying cardiopulmonary disease, ongoing myocardial ischemia or infarction, drug toxicity, or metabolic derangements.…”

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Both supraventricular and ventricular arrhythmias have been identified as independent risk factors for coronary events in the perioperative period (17,116). More recent detailed studies using continuous ECG monitoring found that asymptomatic ventricular arrhythmias, including couplets and nonsustained ventricular tachycardia, were not associated with an increase in cardiac complications after noncardiac surgery (37). Nevertheless, the presence of an arrhythmia in the preoperative setting should provoke a search for underlying cardiopulmonary disease, ongoing myocardial ischemia or infarction, drug toxicity, or metabolic derangements.…”