Postoperative Arrhythmias and Risk Factors after Open Heart Surgery

Chioléro, René; Borgeat, Alain; Fisher, A

doi:10.1055/s-2007-1013937

Cited by 38 publications

(10 citation statements)

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“…De novo ventricular arrhythmias following cardiac surgery is an uncommon but serious complication 6–11 . Some patients are clearly at risk for ventricular arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Ventricular Arrhythmias after Cardiac Surgery:

Brembilla‐Perrot

Villemot

Carteaux

et al. 2003

Pacing Clinical Electrophis

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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.

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“…De novo ventricular arrhythmias following cardiac surgery is an uncommon but serious complication 6–11 . Some patients are clearly at risk for ventricular arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Ventricular Arrhythmias after Cardiac Surgery:

Brembilla‐Perrot

Villemot

Carteaux

et al. 2003

Pacing Clinical Electrophis

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“…Current therapies used for acute HF have several limitations (Table VI). 51–63 In addition, nitroglycerin can lead to neurohormonal activation due to reflex sympathetic activity, which is counterproductive in the setting of decompensated acute HF; it also induces rapid tachyphylaxis requiring frequent titration and ICU admission 70 . Nitroprusside is often difficult to titrate without placement of an arterial line and can be associated with reflex tachycardia, coronary steal, pulmonary shunting, neurohormonal activation due to reflex sympathetic activity, and thiocyanate toxicity.…”

Section: Limitations Of Current Therapies For Acute Heart Failurementioning

confidence: 99%

Management of Acute Decompensated Heart Failure in the Emergency Department

Peacock

Allegra

Ander

et al. 2003

Congestive Heart Failure

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Heart failure, a disease of epidemic proportions, has a tremendous clinical and financial impact on the US health care system. With more than 5 million Americans diagnosed with heart failure and 5‐year mortality approaching 50%, it is the most common cause of hospitalization in patients older than 65 years and is the single most expensive diagnosis in the US health care system. Because the average US hospital loses more than $1000 per heart failure admission, effective therapies that decrease length of stay, reduce hospital costs, and prevent 30‐day readmissions are needed. This article reviews the relevant pathophysiology of heart failure, discusses the newest diagnostic strategies for emergency department diagnoses, evaluates recent advances and effects of early aggressive therapies, and presents a suggested algorithm for the treatment of acutely decompensated heart failure in emergency departments.

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“…It is believed that dopamine is proarrhythmic because it directly activates ␤-adrenergic receptors. 9 In addition, dopamine may decrease serum concentrations of prolactin. 10 Finally, the usefulness of dopamine in the intra-and perioperative settings has been brought into question by recent outcome data on the use of intra-and perioperative dopamine that failed to demonstrate a renoprotective effect.…”

Section: Perioperative Blood Pressure Controlmentioning

confidence: 99%

Fenoldopam: a new parenteral antihypertensive Consensus roundtable on the management of perioperative hypertension and hypertensive crises

Oparil¹

1999

American Journal of Hypertension

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Postoperative Arrhythmias and Risk Factors after Open Heart Surgery

Cited by 38 publications

References 0 publications

Postoperative Ventricular Arrhythmias after Cardiac Surgery:

Postoperative Ventricular Arrhythmias after Cardiac Surgery:

Management of Acute Decompensated Heart Failure in the Emergency Department

Fenoldopam: a new parenteral antihypertensive Consensus roundtable on the management of perioperative hypertension and hypertensive crises

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