Arrhythmias Post Coronary Artery Bypass Surgery

Abstract

Arrhythmias are common after cardiac surgery such as coronary artery bypass grafting surgery. Although most of these arrhythmias are transient and have a benign course, it may represent a significant source of morbidity and mortality. Postoperative arrhythmias (POAs) include atrial tachyarrhythmias, ventricular arrhythmias, and bradyarrhythmias. The incidence of POAs has not changed despite improvements in anesthetic and surgical techniques. The tachyarrhythmias in the postoperative period include atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular tachycardia. The clinical significance of each arrhythmia depends on several factors that include cardiac function, patient's comorbidities, arrhythmia duration, and ventricular response rate. Tachycardia with uncontrolled ventricular rates can cause diastolic and later on systolic dysfunction, reduce cardiac output, and result in hypotension or myocardial ischemia. In the other hand, bradyarrhythmias may have a remarkable influence on patients with systolic or diastolic ventricular dysfunction. Arrhythmia management starts preoperatively with optimizing the patient's condition and controlling patient's risk factors, intraoperatively with careful attention to hemodynamic changes during surgery and uses appropriate anesthesia, and postoperatively with correction of temporary and correctable predisposing factors, as well as specific therapy for the arrhythmia itself. The POAs treatment urgency and management options are determined by the clinical presentation of the arrhythmia.

Heart Rate Variability and Its Role in Predicting Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Graft

“…These results provide new insights into Vietnam’s population. In most previous studies, new-onset AF was assessed from the time of cardiac surgery to hospital discharge or until postoperative day 10 3 , 13 and was detected by continuous ECG telemetry monitoring. The new-onset AF rate after CABG has been variable, ranging from 16.1% to 47.7%.…”

“… 17–19 The incidence of paroxysmal AF has increased from the day of surgery to a peak on postoperative day 2 and has declined steadily thereafter. 3 , 13 Atrium injury caused by cutting and cautery, cardioplegia, atrial stretch, postoperative metabolic changes, and inflammation are all contributing factors to early postoperative AF, usually manifesting on the 2nd or 3rd postoperative day. 3 The divergence in the new-onset AF rate can be explained by the postoperative timing, duration of AF recording, CABG protocol, and pre-existing features.…”

“… 3 , 13 Atrium injury caused by cutting and cautery, cardioplegia, atrial stretch, postoperative metabolic changes, and inflammation are all contributing factors to early postoperative AF, usually manifesting on the 2nd or 3rd postoperative day. 3 The divergence in the new-onset AF rate can be explained by the postoperative timing, duration of AF recording, CABG protocol, and pre-existing features. 3 In contrast to previous studies, in which the rate of new-onset AF was recorded only during cardiac rehabilitation, the AF rate in this study was evaluated using 24-hour Holter monitoring at 7 days, 3 months, and 6 months after surgery.…”

“… 1 CABG is associated with increased autonomic instability of the heart, and the autonomic nervous system may play an important role as a trigger and risk marker for developing atrial fibrillation (AF) after surgery. 2 The occurrence of postoperative AF has been associated with hospitalization, 3 longer length of stay, short-term mortality (one-year mortality), 4 and long-term mortality (four-year mortality). 5 Cerebral stroke occurs in approximately 10% of postoperative AF patients.…”

Potassium and Cardiac Surgery

“…Indeed, arrythmias, especially atrial tachyarrhythmias (e.g. atrial fibrillation, atrial flutter) and, less frequently, ventricular arrhythmias, are a major source of morbidity and mortality following cardiac surgery [82,83].…”