Analysis of perioperative ventricular arrhythmias in valvular heart diseases by holter ECG recording.

Shigemitsu, Osamu; Hadama, Tetsuo; Takasaki, Hidemi; Uchida, Yuzo; Shirabe, Joji; Ito, Morio

doi:10.1253/jcj.55.951

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…The underlying diseased ventricular substrates in VHD may also increase the risk of VTa, which could be supported by the present finding of a higher incidence of CHF in those with VTa after surgical valve replacement. The correlation between VTa and left ventricular (LV) dysfunction in patients with VHD has also been reported in several studies (21)(22)(23)(24)(25)(26)(27). Chronic pressure or volume overload of the myocardium could increase ventricular wall stress and structural remodeling, which subsequently enhances the formation of arrhythmogenic substrates even after surgical valve replacement, despite the fact that regression of ventricular arrhythmia in consonance with the improvement of LV systolic function has been reported after valve replacement (28)(29)(30).…”

Section: Ventricular Tachyarrhythmias In Patients Undergoing Surgical Valve Replacementmentioning

confidence: 84%

Clinical Significance of Ventricular Tachyarrhythmias in Patients Undergoing Valve Replacement: A Nationwide Population-Based Study

Chen

Chien

et al. 2021

Front. Cardiovasc. Med.

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Background: The clinical significance and outcomes of ventricular tachyarrhythmias (VTa) in patients undergoing valve replacement have rarely been reported.Objective: This study aimed to investigate the incidence and outcome of VTa after surgical valve replacement.Methods: We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,212 patients were selected after 1:1 propensity-score matching based on the type of prosthetic valve used (mechanical vs. bioprosthetic). Various outcomes during long-term follow-up were analyzed.Results: After a median follow-up period of 59.6 months, the crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased after surgery. Furthermore, the occurrences of VTa after valve replacement significantly increased the risk of cardiovascular (CV) death (P < 0.001, HR 1.67, 95% CI 1.41–1.96), stroke- (P < 0.001, HR 1.66, 95% CI 1.37–2.01), atrial fibrillation- (P < 0.001, HR 2.80, 95% CI 2.42–3.24), and congestive heart failure-related hospitalization (P < 0.001, HR 2.61, 95% CI 2.30–2.95). Among patients with VTa, all-cause mortality (P = 0.001, HR 0.49, 95% CI 0.32–0.75) and CV death (P = 0.047, HR 0.58, 95% CI 0.34–0.99) in those with implantable cardioverter-defibrillator (ICD) implantation were lower than those without.Conclusion: The crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased during follow-up. The presence of VTa after surgical valve replacement increases hospitalization and CV death, while ICD implantation reduced the mortality rate in these patients.

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Section: Ventricular Tachyarrhythmias In Patients Undergoing Surgical Valve Replacementmentioning

confidence: 84%

Clinical Significance of Ventricular Tachyarrhythmias in Patients Undergoing Valve Replacement: A Nationwide Population-Based Study

Chen

Chien

et al. 2021

Front. Cardiovasc. Med.

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“…In this case, the conventional strategy is to administer lidocaine, magnesium, and various anti-arrhythmic agents, and then repeat defibrillation. However, multiple repeated defibrillations not only increase the risk of myocardial damage and reduce cardiac function, but may also attenuate the fibrillation threshold [11] . Lidocaine and magnesium are generally the common drugs of choice in many hospitals; this includes our institute.…”

Section: Discussionmentioning

confidence: 99%

Energy Level and Success of Internal Defibrillation for Shockable Rhythm during Cardiopulmonary Bypass in Cardiac Surgery: A Retrospective Study

2021

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Internal defibrillation is commonly indicated for shockable rhythm following cross-clamp removal in cardiac surgery. Low energy decreases the success rate of defibrillation but high energy can cause myocardial damage. This study aimed to determine the success rate of internal defibrillation for shockable arrhythmias after cardiac surgery.Retrospective data of 1,424 patients who developed shockable rhythms (ventricular fibrillation or ventricular tachycardia), and required internal defibrillation after aortic cross-clamp removal during cardiac surgery, without deep hypothermic circulatory arrest technique, from August 2015 to July 2017, were reviewed.The overall success rate of internal defibrillation in the first attempt of defibrillation was 61.5%. The success rate of the energy levels at 30, 10, and 7 Jules were 66.7, 64.9, and 61.5%, respectively. The success rate was higher in patients who had a better ejection fraction than those who failed after defibrillation. This was significantly associated with higher pH, higher bicarbonate, lower serum calcium, and lower total cardioplegic volume during cardiopulmonary bypass (CPB). Redo-valve surgery, valvular surgery, and combined coronary artery bypass graft with valvular surgery had a non-significantly lower success rate (p-value = 0.989). Incidence of failure for defibrillate patients in redo-valvular surgery, combined coronary artery bypass graft with valve surgery, adult congenital heart defect, and valvular surgery; requiring four or five shocks was non-significantly increased. Recurrent rate of ventricular fibrillation/ventricular tachycardia was 13.5%.The success rate of internal defibrillation was not related to the dose of energy used after being weaned off CPB.

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Potassium-Induced Cardiac Resetting Technique for Persistent Ventricular Tachycardia and Fibrillation After Aortic Declamping

Watanabe¹,

Yashiki²,

Tomita³

et al. 2011

The Annals of Thoracic Surgery

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Analysis of perioperative ventricular arrhythmias in valvular heart diseases by holter ECG recording.

Cited by 5 publications

References 16 publications

Clinical Significance of Ventricular Tachyarrhythmias in Patients Undergoing Valve Replacement: A Nationwide Population-Based Study

Clinical Significance of Ventricular Tachyarrhythmias in Patients Undergoing Valve Replacement: A Nationwide Population-Based Study

Energy Level and Success of Internal Defibrillation for Shockable Rhythm during Cardiopulmonary Bypass in Cardiac Surgery: A Retrospective Study

Potassium-Induced Cardiac Resetting Technique for Persistent Ventricular Tachycardia and Fibrillation After Aortic Declamping

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