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Valkovec AM, Kram SJ, Henderson JB, Levy JH. Renal Dysfunction and Arrhythmia Association in Patients Receiving Milrinone After Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:353-359. [PMID: 36566129 DOI: 10.1053/j.jvca.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The altered pharmacokinetics of milrinone in renal impairment could result in an increased risk of cardiac arrhythmias. This study aimed to determine if there is an association between new-onset arrhythmias and renal impairment after cardiac surgery following milrinone administration. DESIGN A retrospective cohort study. SETTING A single-center tertiary care hospital. PARTICIPANTS Adult patients who received a milrinone infusion in the intensive care unit (ICU) setting after coronary artery bypass graft, valvuloplasty, annuloplasty, or a combination of these surgeries from July 1, 2014 to July 1, 2021. Renal impairment was defined using a creatinine clearance <60 mL/min, calculated using the Cockcroft-Gault equation. INTERVENTIONS Patients received a weight-based continuous intravenous infusion of milrinone. MEASUREMENTS AND MAIN RESULTS The primary outcome was the presence of new arrhythmias after the initial administration of a weight-based continuous intravenous infusion of milrinone postcardiac surgery. Of the 197 patients who met inclusion, there was no difference in the presence of new arrhythmias (42.9% v 40.3%, p = 0.76) or in the time to first new arrhythmia from milrinone initiation in those with renal impairment compared to those without renal impairment (29.1 hours v 33.3 hours, p = 0.54). Patients with renal impairment had a longer hospital stay than patients without renal impairment (17.5 days v 13.9 days, p = 0.016). Arrhythmia type, length of ICU stay, ICU mortality, and hospital mortality were not different between the cohorts. CONCLUSIONS There was no association between new arrhythmias, milrinone, and renal impairment in patients postcardiac surgery.
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Affiliation(s)
- Amy M Valkovec
- Department of Pharmacy, Duke University Hospital, Durham, NC.
| | - Shawn J Kram
- Department of Pharmacy, Duke University Hospital, Durham, NC
| | | | - Jerrold H Levy
- Departments of Critical Care and Surgery (Cardiothoracic) Duke University Hospital, Duke University, Durham, NC
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Cho MS, Seo HC, Yoon GW, Lee JS, Joo S, Nam GB. Temporal change in repolarization parameters after surgical correction of valvular heart diseases. J Electrocardiol 2023; 79:46-52. [PMID: 36934492 DOI: 10.1016/j.jelectrocard.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Ventricular tachyarrhythmia is a potentially fatal outcome of cardiac surgery. Abrupt changes in the hemodynamics after surgical correction of valvular heart disease (VHD) can lead to alterations in ventricular repolarization. We compared the difference between temporal changes in repolarization parameters after correction of left-sided VHD. METHODS We retrospectively analyzed the electrograms of patients who underwent surgical correction of isolated VHD between 2006 and 2015 at Asan Medical Center, including mitral stenosis (MS), mitral regurgitation (MR), aortic stenosis (AS), and aortic regurgitation (AR). Ventricular repolarization parameters were measured at pre-specified time intervals after index surgery using a custom-made ECG analysis program. We compared repolarization parameters, including QT and corrected QT intervals, T peak-to-end interval, and corrected T peak-to-end interval. RESULTS Analysis of 8265 ECGs from 2110 patients (266 MS, 1059 MR, 421 AS, and 364 AR) was performed. Patients with AS were characterized by older age and more comorbidities than other VHDs. The corrected QT interval showed a peak value immediately after surgery and decreased thereafter in the AS groups. However, a gradual increase over 1 month after surgery in AR, MS, and MR groups was observed. The corrected T peak-to-end interval increased in the MS and MR groups and was unchanged in the AS and AR groups. CONCLUSIONS The repolarization parameters of surgery changed dynamically after left-sided valvular surgery. Understanding differential temporal change of repolarization parameters according to the type of VHD would help clinicians avoid fatal arrhythmias related to the repolarization changes.
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Affiliation(s)
- Min Soo Cho
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo-Chang Seo
- Digital Therapeutics Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Seoul, South Korea
| | - Gi-Won Yoon
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Sung Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Segyeong Joo
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Li W, Liu W, Li H. Electrocardiography is Useful to Predict Postoperative Ventricular Arrhythmia in Patients Undergoing Cardiac Surgery: A Retrospective Study. Front Physiol 2022; 13:873821. [PMID: 35586717 PMCID: PMC9108335 DOI: 10.3389/fphys.2022.873821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Preoperative detection of high-/low-risk postoperative ventricular arrhythmia (POVA) patients using a noninvasive method is an important issue in the clinical setting. This study mainly aimed to determine the usefulness of several preoperative electrocardiographic (ECG) markers in the risk assessment of POVA with cardiac surgery.Method: We enrolled 1024 consecutive patients undergoing cardiac surgery, and a total of 823 patients were included in the study. Logistic regression analysis determined preoperative ECG markers. A new risk predicting model were developed to predict occurrence of POVA, and the receiver operating characteristic curve (ROC) was used to validate this model.Results: Of these, 337 patients experienced POVA, and 485 patients did not experience POVA in this retrospective study. Among 15 ECG markers, a univariate analysis found a strong association between POVA and preoperative VA, the R-wave in lead aVR, the QRS wave, index of cardiac electrophysiological balance (iCEB), QT interval corrected (QTc), Tpeak–Tend interval (Tpe) in lead V2, the J wave in the inferolateral leads, pathological Q wave, and SV1+RV5>35 mm. Multivariate analysis showed that a preoperative J wave [adjusted odds ratio (AOR): 3.80; 95% CI: 1.88–7.66; p < 0.001], Tpe >112.5-ms (AOR: 2.80; 95% CI: 1.57–4.99; p < 0.001), and SV1+RV5 >35 mm (AOR: 2.92; 95% CI: 1.29–6.60; p = 0.01) were independently associated with POVA. A new risk predicting model were developed in predicting POVA.Conclusion: The ECG biomarkers including J wave, Tpe >112.5 ms, and SV1+RV5 >35 mm were significantly predicted POVAs. A risk predicting model developed with electrocardiographic risk markers preoperatively predicted POVAs.
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Pattern Changes in the Heart Rate Variability of Patients Undergoing Coronary Artery Bypass Grafting Surgery. Cardiol Res Pract 2022; 2022:1455025. [PMID: 35535246 PMCID: PMC9078760 DOI: 10.1155/2022/1455025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/12/2022] [Accepted: 03/24/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Coronary artery bypass grafting (CABG) with extracorporeal circulation is a key therapy for coronary artery disease (CAD). However, cardiovascular events and cardiac arrhythmias may still occur in these patients following surgery. Many studies have demonstrated a correlation between cardiac arrhythmias and heart rate variability (HRV). This study aimed to establish the temporal change pattern of HRV observed following CABG. Methods A prospective method was used to study 119 consecutive patients with stable CAD who were assessed using 24-hour Holter recordings 2 days before CABG and 1 week, 3 months, and 6 months after the surgery at Hanoi Heart Hospital from June 2016 to August 2018. Main results: All the time-domain and frequency-domain parameters of HRV decreased precipitately after CABG and were mostly recovered 3 months postoperatively. The percentage of decreased HRV before surgery was 28.6% and 51.8% after 7 days, 19.6% after 3 months, and 12.7% after 6 months. ASDNN and SDNN before and after surgery had the highest rates of change. Conclusion The early decrease in HRV observed 7 days after CABG may be related to the acute effects of the surgery. The recovery of HRV at 3 months after surgery, regardless of the preoperative state of the patients, implies that the autonomic nervous system (ANS) disorder may be improved at this time. At 6 months after surgery, the autonomic nervous injury was recovered in combination with improvement of reperfusion, resulting in improvement in almost all HRV indices compared with those indices preoperatively.
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Khalil F, Toya T, Madhavan M, Badawy M, Ahmad A, Kapa S, Mulpuru SK, Siontis KC, DeSimone CV, Deshmukh AJ, Cha YM, Friedman PA, Munger T, Asirvatham SJ, Killu AM. Characteristics and outcomes of ventricular tachycardia and premature ventricular contractions ablation in patients with prior mitral valve surgery. J Cardiovasc Electrophysiol 2021; 33:274-283. [PMID: 34911151 DOI: 10.1111/jce.15331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/12/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data regarding ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation following mitral valve surgery (MVS) is limited. Catheter ablation (CA) can be challenging given perivalvular substrate in the setting of mitral annuloplasty or prosthetic valves. OBJECTIVE To investigate the characteristics, safety, and outcomes of radiofrequency CA in patients with prior MVS and ventricular arrhythmias (VA). METHODS We identified consecutive patients with prior MVS who underwent CA for VT or PVC between January 2013 and December 2018. We investigated the mechanism of arrhythmia, ablation approach, peri-operative complications, and outcomes. RESULTS In our cohort, 31 patients (77% men, mean age 62.3 ± 10.8 years, left ventricular ejection fraction 39.2 ± 13.9%) with prior MVS underwent CA (16 VT; 15 PVC). Access to the left ventricle was via transseptal approach in 17 patients, and a retrograde aortic approach was used in 13 patients. A combined transseptal and retrograde aortic approach was used in one patient, and a percutaneous epicardial approach was combined with trans-septal approach in one patient. Heterogenous scar regions were present in 94% of VT patients and scar-related reentry was the dominant mechanism of VT. Forty-seven percent of PVC patients had abnormal substrate at the site targeted for ablation. Clinical VA substrates involved the peri-mitral area in six patients with VT and five patients with PVC ablation. No procedure-related complications were reported. The overall recurrence-free rate at 1-year was 72.2%; 67% in the VT group and 78% in the PVC group. No arrhythmia-related death was documented on long-term follow-up. CONCLUSION CA of VAs can be performed safely and effectively in patients with MVS.
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Affiliation(s)
- Fouad Khalil
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Takumi Toya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamed Badawy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Liang Y, Hei F, Guan Y. Electrical storm after correction of an uncomplicated congenital atrial septal defect in an adult: a case report. BMC Cardiovasc Disord 2021; 21:348. [PMID: 34294038 PMCID: PMC8296736 DOI: 10.1186/s12872-021-02164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is a paucity of published literature describing electrical storm after the correction of uncomplicated atrial septal defect (ASD) in an adult. CASE PRESENTATION We present a 49-year-old woman with a congenital ASD combined with mild tricuspid regurgitation who denied any history of arrhythmia or other medical history. She suffered from electrical storm (≥ 3 episodes of ventricular tachycardias or ventricular fibrillations) in the early stage after ASD repair with combined tricuspid valvuloplasty. During electrical storm, her electrolytes were within normal ranges and no ischemic electrocardiographic changes were detected, which suggested that retained air embolism or acute coronary thrombosis were unlikely. Additionally, echocardiographic findings and her central venous pressure (5-8 mmHg during the interval between attacks) failed to support the diagnosis of pericardial tamponade. After a thorough discussion, the surgeons conducted an emergent re-exploration and repeated closure of the ASD with combined DeVega's annuloplasty. Eventually, the patient recovered uneventfully, without reoccurring arrhythmias during follow-up. Although we fail to determine the definite cause, we speculate that the causes probably are iatrogenic injury of the conduction system due to a rare anatomic variation, poor intraoperative protection, latent coronary distortion during tricuspid valvuloplasty, or idiopathic or secondary abnormalities of the conduction system. CONCLUSIONS For most surgeons, performing re-exploration without a known etiology is a difficult decision to make. This case illustrates that re-exploration could be an option when electrical storm occurs in the early stage postoperatively. Nevertheless, surgeons should assess the benefit-risk ratio when taking this unconventional measure.
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Affiliation(s)
- Ying Liang
- Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Feilong Hei
- Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yulong Guan
- Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China.
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Iguina MM, Smithson S, Danckers M. Incessant Refractory Polymorphic Ventricular Tachycardia After Coronary Artery Bypass Graft. Cureus 2021; 13:e12752. [PMID: 33643727 PMCID: PMC7886165 DOI: 10.7759/cureus.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/17/2021] [Indexed: 11/08/2022] Open
Abstract
Polymorphic ventricular tachycardia (PVT) post coronary artery bypass (CABG) surgery is associated with acute myocardial ischemia, hemodynamic instability, and metabolic derangements. When acute ischemia is suspected, a comprehensive investigation for reversible causes is justified to improve patient outcomes. We present a curious case of incessant, refractory PVT in a patient with an unknown etiology requiring percutaneous coronary intervention (PCI) post CABG. The patient was a 73-year-old female with multiple comorbidities who presented to the hospital with anginal chest pain for one day. Initial electrocardiogram (EKG) showed sinus tachycardia with ST-segment depressions in the inferior-lateral leads. Initial cardiac troponin I was elevated at 28.280 ng/mL. Dual antiplatelet therapy and heparin were started. Urgent coronary angiography revealed significant triple-vessel disease, and she subsequently underwent three-vessel CABG. Her postoperative course was complicated by PVT refractory to all antiarrhythmic therapy and ventricular fibrillatory (VF) arrest with the recovery of spontaneous circulation after defibrillation and amiodarone bolus. Despite normal electrolytes and discontinuation of all QT-prolonging agents, PVT persisted. Urgent coronary angiography revealed a patent venous graft to a previously underappreciated severely stenotic distal segment of the left anterior descending artery (LAD). She underwent PCI of the culprit lesion with the termination of PVT. Although acute graft failure is regularly the culprit for acute myocardial infarction perioperatively, emergent coronary angiography post coronary bypass surgery revealed patent grafts and a previously underestimated severe coronary lesion contributing to ongoing ischemia. Post CABG percutaneous coronary intervention (PCI) yielded a complete resolution of her arrhythmia.
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Affiliation(s)
- Michele M Iguina
- Internal Medicine, Aventura Hospital and Medical Center, Aventura, USA
| | - Shaun Smithson
- Cardiology, Aventura Hospital and Medical Center, Aventura, USA
| | - Mauricio Danckers
- Critical Care Medicine, Aventura Hospital and Medical Center, Aventura, USA
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Abstract
High-value CCC is rapidly evolving to meet the demands of increased patient acuity and to incorporate advances in technology. The high-performing CCC system and culture should aim to learn quickly and continuously improve. CCC demands a proactive, interactive, precise, an expert team, and continuity.
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Early ventricular tachyarrhythmias after coronary artery bypass grafting surgery: Is it a real burden? J Cardiol 2017; 70:263-270. [PMID: 28069327 DOI: 10.1016/j.jjcc.2016.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/21/2016] [Accepted: 12/13/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prevalence of ventricular dysrhythmias (VD) [ventricular premature beats (VPBs), ventricular couplets (Vcouplets), ventricular runs (Vruns)] after coronary artery bypass grafting (CABG) has so far not been examined. The goal of this study is to examine characteristics of VD and whether they precede ventricular tachyarrhythmias (VTA) during a postoperative follow-up period of 5 days using continuous rhythm registrations. In addition, we determined predictive factors of VD/VTA. METHODS Incidences and burdens of VD/VTA were calculated in patients (N=105, 83 male, 65±9 years) undergoing primary, on-pump CABG. Independent risk factors were examined using multivariate analysis. RESULTS VPBs, Vcouplets, and Vruns occurred in respectively 100%, 82.9%, and 48.6% with corresponding burdens of 0.05%, 0%, and 0%. Sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) did not occur in our cohort. Independent risk factors for VD included male gender, mitral valve insufficiency, hyperlipidemia, and age ≥60 years. CONCLUSIONS VD are common in patients with coronary artery disease after CABG. Despite high incidences of these dysrhythmias, corresponding burdens are low and sustained VT or VF did not occur. Incidences were highest on the first postoperative day and diminished over time.
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Fibrilación auricular y poblaciones especiales. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Nageh MF, Kim JJ, Chen LH, Yao JF. Implantable defibrillators for secondary prevention of sudden cardiac death in cardiac surgery patients with perioperative ventricular arrhythmias. J Am Heart Assoc 2014; 3:jah3603. [PMID: 25146702 PMCID: PMC4310357 DOI: 10.1161/jaha.113.000686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Randomized studies of implantable cardioverter defibrillators (ICD) have excluded sudden cardiac death survivors who had revascularization before or after an arrhythmic event. To evaluate the role of ICD and the effects of clinical variables including degree of revascularization, we studied cardiac surgery patients who had an ICD implanted for sustained perioperative ventricular arrhythmias. Methods and Results The electronic database for Southern California Kaiser Foundation hospitals was searched for patients who had cardiac surgery between 1999 and 2005 and an ICD implanted within 3 months of surgery. One hundred sixty‐four patients were identified; 93/164 had an ICD for sustained pre‐ or postoperative ventricular tachycardia or fibrillation requiring resuscitation. Records were reviewed for the following: presenting arrhythmia, ejection fraction, and degree of revascularization. The primary end point was total mortality (TM) and/or appropriate ICD therapy (ICD‐T), and secondary end points are TM and ICD‐T. During the mean follow up of 49 months, the primary endpoint of TM+ICD‐T and individual end points of TM and ICD‐T were observed in 52 (56%), 35 (38%), and 28 (30%) patients, respectively, with 55% of TM, and 23% of ICD‐T occurring within 2 years of implant. In multivariate risk analysis, none of the following was associated with any of the end points: incomplete revascularization, presenting ventricular arrhythmia, and timing of arrhythmias. Conclusion Our data supports the recent guidelines for ICD in this cohort of patients, as the presence of irreversible substrate and triggers of ventricular arrhythmias, cannot be reliably excluded even with complete revascularization. Further studies are needed to understand this complex group of patients.
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Affiliation(s)
- Maged F Nageh
- Department of Electrophysiology, Kaiser Permanente Southern California, Los Angeles, CA (M.F.N.)
| | - John J Kim
- Department of Cardiology, Kaiser Permanente Southern California, Los Angeles, CA (J.J.K.)
| | - Lie-Hong Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA (L.H.C., J.F.Y.)
| | - Janis F Yao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA (L.H.C., J.F.Y.)
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Almdahl SM, Veel T, Eide M, Damstuen J, Halvorsen P, Mølstad P. Postcardioplegia ventricular fibrillation: no impact on subsequent survival. SCAND CARDIOVASC J 2014; 48:249-54. [PMID: 24814392 DOI: 10.3109/14017431.2014.922212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES At aortic declamping after cardioplegic cardiac arrest, the initial rhythm can be broadly classified as ventricular fibrillation (VF) or non-VF. VF can be treated with potassium-induced conversion and direct-current countershock is only applied if potassium treatment fails. We aimed to investigate whether there are any differences between these groups of patients in regard to outcomes. DESIGN From January 1999 through December 2010, 12,113 patients underwent various types of cardiac surgery. Data from every patient were consecutively registered. Survival was established through the Norwegian National Registry. Cox multivariable modeling with adjustment for clinical, biochemical, and medication baseline data was used for survival analysis. RESULTS The mean follow-up time was 7.4 years and total patient-years were 89,268. The percentage of all-cause deaths was 24.9. Adjusted survival for patients with no postcardioplegia VF (n = 9723) and patients with successful potassium-induced conversion (n = 1877) was completely identical. Four hundred patients with electrical conversion after failed potassium treatment had a nonsignificant trend toward an increased mortality (hazard ratio, 95% confidence interval: 1.19 (0.99-1.4); p = 0.07). CONCLUSIONS This is the first study reporting the association between postcardioplegia VF, its treatment with potassium and outcome. No impact was found on outcome as judged by all-cause mortality.
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Sadr-Ameli MA, Alizadeh A, Ghasemi V, Heidarali M. Ventricular tachyarrhythmia after coronary bypass surgery: incidence and outcome. Asian Cardiovasc Thorac Ann 2013; 21:551-7. [PMID: 24570557 DOI: 10.1177/0218492312462225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular tachyarrhythmia after coronary artery bypass graft is common and the occurrence has been described, but the incidence and risk factors are not well defined. AIM To evaluate the incidence of arrhythmias and to detect high-risk populations. METHODS In this prospective study, 856 consecutive patients undergoing coronary artery bypass graft were monitored for new-onset ventricular tachyarrhythmias: non-sustained monomorphic ventricular tachyarrhythmia, sustained monomorphic ventricular tachyarrhythmia, sustained polymorphic ventricular tachyarrhythmia, and ventricular fibrillation. Detailed analyses of the clinical, demographic, echocardiographic, and surgical findings and arrhythmias occurrence was carried out during 6 months of follow-up. RESULTS The incidence of ventricular tachyarrhythmia was 26.6% (17.6% non-sustained monomorphic ventricular tachycardia, 5.5% sustained monomorphic ventricular tachycardia, 0.8% sustained polymorphic ventricular tachycardia, and 2.7% ventricular fibrillation). The strongest degrees of statistical significance were for low ejection fraction (p = 0.01) and ischemic heart disease (p = 0.02). The incidence of ventricular fibrillation (61%) was greatest in the first 48 h after surgery. Postoperative myocardial infarction (p = 0.03) and hemodynamic instability (p = 0.05) were also predictors of arrhythmia occurrence. Recurrence of arrhythmia was highest in the ventricular fibrillation group (52%). The correlations between tachyarrhythmia, age, sex, electrolyte disorders, body mass index, and systemic or pulmonary hypertension were not significant. CONCLUSION In view of the strong relationship between ventricular arrhythmias and low ejection fraction, ischemic heart disease, coronary artery disease severity, postoperative myocardial infection, and hemodynamic impairment, continuous monitoring is necessary, especially in the first 48 h after coronary artery bypass surgery.
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Affiliation(s)
- Mohammad Ali Sadr-Ameli
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
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El-Chami MF, Sawaya FJ, Kilgo P, Stein W, Halkos M, Thourani V, Lattouf OM, Delurgio DB, Guyton RA, Puskas JD, Leon AR. Ventricular Arrhythmia After Cardiac Surgery. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.1011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Transaortic ablation of incessant ventricular tachycardia after aortic valve replacement by a mechanical prosthesis. COR ET VASA 2010. [DOI: 10.33678/cor.2010.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Enríquez F, Jiménez A. Taquiarritmias postoperatorias en la cirugía cardíaca del adulto. Profilaxis. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70100-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Enríquez F, Jiménez A. Tratamiento de las taquiarritmias postoperatarias en la cirugía cardíaca del adulto. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Leeuwenburgh BPJ, Versteegh MIM, Maas JJ, Dunning J. Should amiodarone or lidocaine be given to patients who arrest after cardiac surgery and fail to cardiovert from ventricular fibrillation? Interact Cardiovasc Thorac Surg 2008; 7:1148-51. [DOI: 10.1510/icvts.2008.188656] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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21
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Amar D. Prevention and management of perioperative arrhythmias in the thoracic surgical population. Anesthesiol Clin 2008; 26:325-35, vii. [PMID: 18456217 DOI: 10.1016/j.anclin.2008.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although bradyarrhythmias or malignant ventricular tachyarrhythmias have been reported in less than 1% of patients following noncardiac surgery, rapid atrial arrhythmias more frequently affect the elderly who undergo thoracic operations. This article focuses on new issues leading to the improved understanding of the pathophysiology and mechanisms of postoperative atrial arrhythmias. It discusses new risk factors and a prediction rule for postthoracotomy atrial fibrillation (AF), reviews prophylaxis and acute therapeutic interventions for postthoracotomy AF, and highlights the most recent recommendations of the American Heart Association Task Force on the management of patients who have AF with emphasis on preventing thromboembolic events.
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Affiliation(s)
- David Amar
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Myredal A, Karlsson AK, Johansson M. Elevated temporal lability of myocardial repolarization after coronary artery bypass grafting. J Electrocardiol 2008; 41:698-702. [PMID: 18640686 DOI: 10.1016/j.jelectrocard.2008.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Ventricular arrhythmias are uncommon after coronary artery bypass grafting (CABG), but the incidence and mortality are high in certain subsets of patients during the early recovery after surgery. Elevated temporal lability of myocardial repolarization has been associated with sudden cardiac death. The aim of the current study was to explore temporal variability of myocardial repolarization during both early and longtime follow-up after CABG. METHODS AND RESULTS Patients (n = 61) who had undergone CABG and healthy subjects (HS, n = 33) were examined. Electrocardiogram and beat-to-beat blood pressure were recorded at 5 weeks and 5 months after surgery. The QT variability index (QTVI) was calculated as the log ratio between the temporal variabilities of the QT and RR intervals. The QTVI and QT variances were elevated by 40% and 44%, whereas RR variances were reduced by 40% among patients 5 weeks after CABG compared to HS (-0.90 +/- 0.59, 29 +/- 30, and 1223 +/- 1895 ms(2) vs -1.50 +/- 0.29, 15 +/- 16, and 2200 +/- 2877 ms(2) for HS; P < .01 for all). The QTVI and QT variances decreased by 38% and 31% between 5 weeks and 5 months after CABG, whereas the RR variances increased by 51% (P < .01 for all). The QTVI values remained elevated among patients compared to HS at 5 months after CABG (P < .01), whereas QT and RR variances did not differ. CONCLUSION Elevated temporal lability of myocardial repolarization prevails particularly during the early recovery phase after CABG and may reflect increased susceptibility to ventricular arrhythmia.
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Affiliation(s)
- Anna Myredal
- Department of Internal Medicine, Varberg Hospital, Varberg, Sweden.
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Abstract
Background—
The causes of sustained monomorphic ventricular tachycardia (VT) after cardiac valve surgeries have not been studied extensively, although bundle-branch reentry has been reported.
Methods and Results—
Records of 496 patients referred for electrophysiology study and catheter ablation of recurrent VT were reviewed. Twenty patients (4%) had VT after aortic or mitral valve surgery in the absence of known myocardial infarction. The median age was 53 years, and the median ejection fraction was 45%. In 4 patients, VT occurred early after surgery, and electrophysiology study was performed 3 to 10 days later. In the remaining patients, electrophysiology study was performed a median of 12 years (interquartile range 5 to 15 years) after surgery. Sustained VT was inducible in 17 patients. VT was attributed to scar-related reentry in 14 patients (70%) and to bundle-branch reentry in 2 (10%). Multiple VTs were present in 9 of 14 patients with scar-related reentry. A total of 42 induced VTs were targeted for ablation. Of the 14 patients with scar-related reentry, 9 (64%) had periannular scar, and 10 (71%) had an identifiable endocardial circuit isthmus. Ablation abolished 41 (98%) of the 42 targeted VTs. At a median follow-up of 2.1 years, 3 deaths occurred 8 to 14 months after ablation. One patient with incessant VT early after valve surgery suffered a stroke with residual hemianopsia. Of the 20 patients, 3 required repeat ablation after recurrence, and 2 of these who were not inducible during electrophysiology study had clinical recurrence that necessitated ablation.
Conclusions—
Sustained VT after valve surgery appears to be bimodal in presentation, occurring either early after surgery or years later. In this referral population, reentry in a region of scar is more common than bundle-branch reentry. Catheter ablation can be successful.
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Chamchad D, Djaiani G, Jung HJ, Nakhamchik L, Carroll J, Horrow JC. Nonlinear Heart Rate Variability Analysis May Predict Atrial Fibrillation After Coronary Artery Bypass Grafting. Anesth Analg 2006; 103:1109-12. [PMID: 17056940 DOI: 10.1213/01.ane.0000239330.45658.76] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Heart rate variability might predict arrhythmias after coronary artery bypass grafting. METHODS Off-line processing of 10-min electrocardiogram recordings of consecutive patients provided R-R intervals for time domain, frequency domain, Poincaré, and point correlation analyses and subsequent association with postoperative atrial fibrillation by stepwise multivariate logistic regression. RESULTS Of 88 patients who met entry criteria, 13 developed atrial fibrillation. Peak point correlation dimension (odds ratio 3.985/unit, P = 0.0096) and age (odds ratio 1.144/yr, P = 0.0019) were independently associated with atrial fibrillation (c-statistic = 0.839). CONCLUSIONS Further study should confirm the ability of peak point correlation dimension to predict atrial fibrillation after coronary artery surgery with cardiopulmonary bypass.
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Affiliation(s)
- Dmitri Chamchad
- Department of Anesthesia, Lankenau Hospital, Wynnewood, Pennsylvania, USA
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Bagshaw SM, Galbraith PD, Mitchell LB, Sauve R, Exner DV, Ghali WA. Prophylactic Amiodarone for Prevention of Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis. Ann Thorac Surg 2006; 82:1927-37. [PMID: 17062287 DOI: 10.1016/j.athoracsur.2006.06.032] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 06/07/2006] [Accepted: 06/12/2006] [Indexed: 11/26/2022]
Abstract
Amiodarone has been proposed to decrease atrial fibrillation after cardiac surgery. The literature was systematically reviewed for randomized trials comparing amiodarone with control for prevention of atrial fibrillation. Data were extracted on study characteristics, quality, and incidence of atrial fibrillation, cardiovascular outcomes, and length of hospitalization. Nineteen trials were included. Amiodarone reduced the odds ratio of atrial fibrillation (0.50; 95% confidence interval [CI]: 0.43 to 0.59, p < 0.0001), ventricular tachyarrhythmias (0.39; 95% CI: 0.26 to 0.58, p < 0.0001), and strokes (0.53; 95% CI: 0.30 to 0.92, p = 0.02). Amiodarone reduced hospital stay (0.6 days; 95% CI: 0.4 to 0.8, p < 0.0001). Amiodarone decreased atrial fibrillation, reduced perioperative ventricular tachyarrhythmias and strokes, and reduced duration of hospitalization. The current evidence supports recommending the routine use of perioperative amiodarone for cardiac surgery.
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Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
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Yavuz B, Duman U, Abali G, Dogan OF, Yazicioglu A, Sahiner L, Aytemir K, Tokgozoglu L, Demircin M, Nazli N, Kabakci G, Oto A. Coronary Artery Bypass Grafting Is Associated with a Significant Worsening of QT Dynamicity and Heart Rate Variability. Cardiology 2006; 106:51-5. [PMID: 16612069 DOI: 10.1159/000092599] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 03/01/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Imbalance in autonomic nervous system and impaired myocardial repolarization has been shown to increase the risk for arrhythmias in patients with coronary artery disease. This study evaluated the effects of coronary artery bypass grafting (CABG) on heart rate variability and QT interval dynamicity in subjects with coronary artery disease undergoing elective CABG surgery. METHODS The study group consisted of 68 consecutive patients (mean age +/-SD: 61 +/- 9 years) with coronary artery disease who underwent elective CABG. Twenty-four-hour Holter monitoring was performed 2-5 days before cardiac surgery and was repeated 10 days after CABG. ELATEC holter software was used to calculate heart rate variability and QT dynamicity parameters. All subjects had a complete history, laboratory examination and transthoracic echocardiography. RESULTS All patients had beta-blocking agent medication pre- and postoperatively. Standard deviation of all NN intervals for a selected time period, square root of the mean of the sum of the squares of differences between adjacent RR intervals, the proportion of differences in successive NN intervals greater than 50 ms, normalized low-frequency power, and normalized high-frequency power were significantly decreased after CABG surgery, whereas low-frequency/high-frequency ratio was significantly increased after CABG. QT/RR slopes over 24 h were significantly increased after CABG surgery for QT end and QT apex (QTapex/RR: 0.16 +/- 0.13 vs. 0.28 +/- 0.19, p < 0.001; QTend/RR: 0.18 +/- 0.13 vs. 0.36 +/- 0.23, p < 0.001). CONCLUSION This prospective study showed for the first time that CABG was associated with a significant worsening of heart rate variability and QT dynamicity parameters in the postoperative period.
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Affiliation(s)
- Bunyamin Yavuz
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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