Unexpected ventricular tachyarrhythmias soon after cardiac surgery

Sapin, Peter M.; Woelfel, Alan; Foster, J. W.

doi:10.1016/0002-9149(91)90505-f

Cited by 23 publications

(11 citation statements)

References 5 publications

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“…Some patients required aggressive antiarrhythmic therapy to stabilize and were then treated with empirical amiodarone therapy. However, 5 patients were studied, and all exhibited provokable monomorphic VT that resembled the clinical VT, a finding similar to some previous reports, 7,8 although others report a lower frequency of inducible VT. 9,10 Along with the clinical data described above, the presence of inducible VT supports the premise that a fixed substrate for VT was present that could represent a long-term risk; thus, all were treated with an implantable defibrillator or amiodarone. When inducible VT is absent, some have suggested that long-term therapy is not required, presumably indicating that a transient high-risk process had resolved.…”

Section: Results Of Electrophysiological Study and Long-term Managementmentioning

confidence: 55%

“…When inducible VT is absent, some have suggested that long-term therapy is not required, presumably indicating that a transient high-risk process had resolved. 9,10 In the patients in our series who received ICDs, 1 of 3 patients subsequently experienced an appropriate therapeutic intervention by the ICD. We cannot be certain as to the long-term need or benefit of either ICDs or amiodarone in these patients, but the presence of sustained VT, LV dysfunction, and prior MI prompted these therapeutic decisions.…”

Section: Results Of Electrophysiological Study and Long-term Managementmentioning

confidence: 97%

“…This may take the form of the benign presence of increased ventricular ectopy, 4 but more importantly, the de novo occurrence of ventricular tachyarrhythmia as a consequence of bypass tract surgery has been reported. [5][6][7][8][9][10] Several case reports and small series [5][6][7][8][9][10] have anecdotally described the development of sustained VT in the recovery period after CABG, but the incidence, mortality rate, long-term followup, and mechanism underlying arrhythmia occurrence are poorly defined.…”

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confidence: 99%

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New-Onset Sustained Ventricular Tachycardia After Cardiac Surgery

et al. 1999

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Background-The de novo occurrence of sustained ventricular tachycardia (VT) after CABG has been described, but the incidence, mortality rate, long-term follow-up, and mechanism are not well defined. Methods and Results-This prospective study enrolled consecutive patients undergoing CABG at a single institution.Patients were followed up for the development of sustained VT, and a detailed analysis of clinical, angiographic, and surgical variables associated with the occurrence of VT was performed. A total of 382 patients participated, and 12 patients (3.1%) experienced Ն1 episode of sustained VT 4.1Ϯ4.8 days after CABG. In 11 of 12 patients, no postoperative complication explained the VT; 1 patient had a perioperative myocardial infarction. The in-hospital mortality rate was 25%. Patients with VT were more likely to have prior myocardial infarction (92% versus 50%, PϽ0.01), severe congestive heart failure (56% versus 21%, PϽ0.01), and ejection fraction Ͻ0.40 (70% versus 29%, PϽ0.01). When all 3 factors were present, the risk of VT was 30%, a 14-fold increase. Patients with VT had more noncollateralized totally occluded vessels on angiogram (1.4Ϯ0.97 versus 0.54Ϯ0.7, PϽ0.01), a bypass graft across a noncollateralized occluded vessel (1.50Ϯ1.0 versus 0.42Ϯ0.62, PϽ0.01), and a bypass graft across a noncollateralized occluded vessel to an infarct zone (1.50Ϯ1.0 versus 0.17Ϯ0.38, PϽ0.01). By multivariate analysis, the number of bypass grafts across a noncollateralized occluded vessel to an infarct zone was the only independent factor predicting VT. Conclusions-The first presentation of sustained monomorphic VT in the recovery period after CABG is uncommon, but the incidence is high in specific clinical subsets. Placement of a bypass graft across a noncollateralized total occlusion in a vessel supplying an infarct zone was strongly and independently associated with the development of VT. (Circulation. 1999;99:903-908.)

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Section: Results Of Electrophysiological Study and Long-term Managementmentioning

confidence: 55%

Section: Results Of Electrophysiological Study and Long-term Managementmentioning

confidence: 97%

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confidence: 99%

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New-Onset Sustained Ventricular Tachycardia After Cardiac Surgery

et al. 1999

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“…Sustained ventricular arrhythmias are uncommon after surgery and include ventricular tachycardia (VT) and ventricular fibrillation (VFib). Reported incidences after cardiac surgery range from 0.41% to 1.4% [140, 143]. …”

Section: Ventricular Tachyarrhythmiasmentioning

confidence: 99%

Postoperative Arrhythmias after Cardiac Surgery: Incidence, Risk Factors, and Therapeutic Management

Peretto

Durante

Limite

et al. 2014

Cardiology Research and Practice

185

110

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Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. In this setting, atrial fibrillation is the most common heart rhythm disorder. Postoperative atrial fibrillation is often self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. However, ventricular arrhythmias and conduction disturbances can also occur. Sustained ventricular arrhythmias in the recovery period after cardiac surgery may warrant acute treatment and long-term preventive strategy in the absence of reversible causes. Transient bradyarrhythmias may be managed with temporary pacing wires placed at surgery, but significant and persistent atrioventricular block or sinus node dysfunction can occur with the need for permanent pacing. We provide a complete and updated review about mechanisms, risk factors, and treatment strategies for the main postoperative arrhythmias.

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“…13 Postoperative arrhythmia is one of the most frequent early postoperative complications after CABG surgery and is associated with increased morbidity and mortality. [14][15][16][17] Arrhythmia occurs frequently in patients with depression, irrespective of the presence of coronary artery disease. [18][19][20][21][22][23] One of the plausible mechanisms explaining the relationship between depression and arrhythmia is autonomic dysfunction.…”

Section: Résumémentioning

confidence: 99%