Ventricular arrhythmias after coronary artery bypass graft surgery: Incidence, risk factors and long-term prognosis

Rubin, David A.; Nieminski, Karen E.; Monteferrante, J. C.; Magee, T.; Reed, George E.; Herman, Michael V.

doi:10.1016/s0735-1097(85)80165-0

Cited by 34 publications

(18 citation statements)

References 7 publications

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“…In accordance with previous studies [1,2] pre-and postoperative isolated ventricular premature beats and nonsustained VT did not appear significantly related to postoperative sustained VT onset. On the other hand, patients with VT exhibited more severe coronary artery disease (CAD), and consequently received a greater number of CABGs than those remaining in sinus rhythm (SR).…”

Section: Discussionsupporting

confidence: 92%

“…Ventricular arrhythmias, such as isolated ventricular premature beats and nonsustained ventricular tachycardia, occur commonly after coronary surgery, and do not seem to adversely affect the prognosis of patients with preserved left ventricular systolic function [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Sustained ventricular tachyarrhythmias (VT), such as monomorphic or polymorphic ventricular tachycardia and ventricular fibrillation, represent the most serious arrhythmic events that can complicate the postoperative course of coronary artery bypass grafting (CABG), even though their incidence is definitely lower compared with that of atrial fibrillation and of nonsustained ventricular tachycardia [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. VT carries a high mortality risk, both during the acute phase and after hospital discharge [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery

et al. 1999

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Sustained ventricular tachyarrhythmias (VT), such as monomorphic or polymorphic ventricular tachycardia, and ventricular fibrillation, represent the most serious arrhythmic events that can complicate the postoperative course of coronary artery bypass grafting (CABG). The perioperative factors potentially associated with post-CABG sustained VT onset have not been thoroughly investigated. As a consequence, the aim of our study was to identify which perioperative variables might predict post-CABG VT occurrence. One hundred and fifty-two consecutive patients who underwent CABG surgery at our Institute were included in the study. Post-CABG VT occurred in 13 out of 152 patients (8.5%, six cases of monomorphic ventricular tachycardia and seven cases of ventricular fibrillation). Univariate analysis revealed that VT patients were significantly younger (54.8 +/- 6.6 vs 60.1 +/- 8.8, P = 0.038), exhibited more severe coronary artery disease (CAD) (no. of diseased vessels, 2.92 +/- 0.3 vs 2.45 +/- 0.7, P = 0.023; and percentage of patients with three-vessel CAD, 91.7 vs 57.3%, P = 0.043), and received a greater number of CABGs than those remaining in sinus rhythm (SR) (percentage of patients receiving three or more CABGs, 76.9 vs 38.8%, P = 0.018) Moreover, VT patients more frequently developed intra- or postoperative myocardial infarction (total CK > 1,000, 76.9 vs 38%, P = 0.016; and MB-CK > normal range, 72.7 vs 30.7%, P = 0.014), electrolyte derangement (84.6 vs 45.6%, P = 0.017), and a severe hemodynamic impairment (need for intra-aortic balloon pump (IABP), 23 vs 2.9%, P = 0.009). On multivariate analysis, total CK > 1,000, postoperative electrolyte imbalance, the need for three or more CABGs, and for IABP all were independent correlates for VT. In conclusion, post-CABG VT seem to be related to the preexistence of a severe underlying coronary artery disease along with perioperative triggering factors, such as acute ischemia, electrolytic disorders, and sudden hemodynamic impairment.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery

et al. 1999

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“…4 whom serious ventricular arrhythmias occurred shortly after spontaneous relief of episodes of coronary spasm-induced silent ischaemia (Tzivoni et al, 1983), or in whom persistent arrhythmias followed successful thrombolysis (Goldberg et al, 1983), or during reperfusion of the whole heart after a period of surgically-induced ischaemic arrest (Rubin et al, 1985). Despite the potential importance of post-ischaemic reperfusion arrhythmias, the effects of pharmacological K ATP activation on these arrhythmias have been reported infrequently, especially in the absence of arrhythmias during the preceding phase of ischaemia (Ferdinandy et al, 1995;Tosaki et al, 1993;Tanaka et al, 1996).…”

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confidence: 99%

A KATP channel opener inhibited myocardial reperfusion action potential shortening and arrhythmias

Workman

Mackenzie

Northover

2001

European Journal of Pharmacology

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Low concentrations of certain K ATP openers have been reported to exert a moderate inhibitory effect on arrhythmias during post-ischaemic early myocardial reperfusion, but the accompanying effects on the time course of changes in action potentials in intact hearts have not yet been studied.We report that, in rat isolated hearts reperfusion following 10 min of regional no-flow ischaemia was associated with both an acute, marked, but transient, shortening of ventricular repolarisation (by 63%) during reperfusion, and a high incidence (90%) of ventricular tachyarrhythmias. The K ATP opener Ro 31-6930 [2-(6-cyano-2,2-dimethyl-2H-1-benzopyran-4-yl)-pyridine 1-oxide] delivered prior to ischaemia at a relatively low concentration (0.5 µM), significantly reduced the incidence and duration of reperfusion arrhythmias, and prevented the associated acute action potential shortening during reperfusion, each in a glibenclamide (1 µM)-sensitive manner (P<0.05, n=10-15 hearts). This was associated with a moderate, and non-arrhythmogenic, action potential shortening during ischaemia (a potentially "cardioprotective" effect). However, these data highlight the potential harm these drugs may cause, since a higher concentration of Ro 31-6930 caused marked shortening of action potentials and significant pro-arrhythmia during ischaemia. KeywordsATP-sensitive potassium channel; Reperfusion; Isolated heart; Action potential; Ventricular arrhythmias. 1: IntroductionCardiac adenosine triphosphate-sensitive K + (K ATP ) channels, first identified in the sarcolemma (Noma, 1983), and more recently in the mitochondria (Inoue et al., 1991) are thought to remain closed under physiological conditions. It is well recognised that under certain pathological conditions, such as myocardial ischaemia, however, opening of sarcolemmal K ATP channels may contribute to the shortening of action potential duration (Wilde and Janse, 1994; Wilde, 1997). We recently reported (Workman et al., 2000) that in the rat isolated heart, ischaemia in the presence (but not the absence) of pharmacological K ATP activation, caused action potential shortening of a sufficient degree to cause ventricular tachyarrhythmias.It is also recognised that K ATP activation-induced action potential shortening, under certain conditions may help to protect the myocardium from the injury caused by excessive Ca 2+ influx and ATP consumption [see (Grover and Garlid, 2000) for recent review]. Several studies have highlighted the protective effects on the myocardium of pharmacological K ATP activation. In many cases such protection was demonstrated during post-ischaemic reperfusion. For example, K ATP openers have been shown, during reperfusion, to improve recovery of contractile function (Docherty et al., 1997), to restrain the rise in the intracellular Ca 2+ concentration, [Ca 2+ ] i (Behling and Malone, 1995), to enhance the restoration of high energy phosphates (Tanonaka et al., 1999), as well as limiting the extent of myocardial infarction after reperfusion (Grover et al., 1...

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“…There is, however, a specific subset of patients whose ventricular arrhythmias are aggravated by the surgical procedure. 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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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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Ventricular arrhythmias after coronary artery bypass graft surgery: Incidence, risk factors and long-term prognosis

Cited by 34 publications

References 7 publications

Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery

Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery

A KATP channel opener inhibited myocardial reperfusion action potential shortening and arrhythmias

New-Onset Sustained Ventricular Tachycardia After Cardiac Surgery

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