De novo monomorphic and polymorphic ventricular tachycardia following coronary artery bypass grafting

Azar, Rabih R.; Berns, Ellison; Seecharran, Bonnie; Veronneau, Joan; Lippman, Neal; Kluger, Jeffrey

doi:10.1016/s0002-9149(97)00287-7

Cited by 24 publications

(12 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Acute myocardial ischaemia resulting from graft failure or inadequate myocardial protection may precipitate ventricular arrhythmias both intraoperatively and postoperatively. Furthermore, ventricular arrhythmias may be triggered by scar tissue and hibernating myocardium in patients with previous ischaemic injury,33 34 factors unlikely to be influenced by the administration of antioxidant therapy.…”

Section: Discussionmentioning

confidence: 99%

Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials

Harling

Rasoli

Vecht

et al. 2011

Heart

View full text Add to dashboard Cite

The prophylactic use of vitamins C and E may significantly reduce the incidence of POAF and all-cause arrhythmia following cardiac surgery. However, the overall quality of current studies is poor and further research should focus on adequately powered randomised controlled trials that standardise AF reporting, antioxidant protocol and the use of concomitant agents. Cost analysis should be considered to establish the potential economic benefit of antioxidant vitamin prophylaxis in POAF.

show abstract

Section: Discussionmentioning

confidence: 99%

Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials

Harling

Rasoli

Vecht

et al. 2011

Heart

View full text Add to dashboard Cite

show abstract

“…Recent papers have outlined the importance of a preexisting anatomical and electrical substrate that may favor the occurrence of VT after coronary surgery [8,10]. It also seems that de novo monomorphic and polymorphic ventricular tachycardias are generated by different electrophysiological mechanisms [8].…”

Section: Discussionmentioning

confidence: 99%

“…It also seems that de novo monomorphic and polymorphic ventricular tachycardias are generated by different electrophysiological mechanisms [8]. In fact, monomorphic ventricular tachycardia seems more common in patients with a depressed ejection fraction and a prior history of myocardial infarction, and who would exhibit a much higher inducibility rate on electrophysiological study, suggesting a pre-existing underlying arrhythmogenic substrate.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, monomorphic ventricular tachycardia seems more common in patients with a depressed ejection fraction and a prior history of myocardial infarction, and who would exhibit a much higher inducibility rate on electrophysiological study, suggesting a pre-existing underlying arrhythmogenic substrate. On the other hand, polymorphic ventricular tachycardia seems to be more related to perioperative triggering factors like myocardial ischemia or infarction, electrolyte disorders, adrenergic stimulation, etc., even though preexisting favorable conditions (i.e., prior myocardial infarction, left ventricular systolic impairment) might certainly play a role [8].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery

et al. 1999

View full text Add to dashboard Cite

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.

show abstract

“…De novo ventricular arrhythmias following cardiac surgery is an uncommon but serious complication 6–11 . Some patients are clearly at risk for ventricular arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Ventricular Arrhythmias after Cardiac Surgery:

Brembilla‐Perrot

Villemot

Carteaux

et al. 2003

Pacing Clinical Electrophis

View full text Add to dashboard Cite

AF is frequent after cardiac surgery. However, ventricular arrhythmias are less known. The purpose of the study was to evaluate the causes and the prognostic significance of severe ventricular arrhythmias occurring after cardiac surgery. For 10 years, among 2,100 cardiac surgeries, 16 (0.8%) patients (13 men, 3 women; age 49-71 years, mean 62 +/- 9 years) without previous ventricular arrhythmias, with preserved left ventricular ejection fraction, and without acute cause of ventricular arrhythmias, developed VF (n = 4) or a sustained VT between 3 days and 3 weeks after cardiac surgery (coronary artery bypass grafting [n = 6], valve replacement [n = 10]). Rapid AF (n = 5) or slow AF (n = 1) were present at the time of VT/VF. Programmed ventricular stimulation occurred after up to three extrastimuli in the basal state and after infusion of 20-30 micrograms of isoproterenol. An echocardiogram, coronary angiography, Holter monitoring with heart rate variability (HRV) study were performed. Ventricular stimulation was negative in six patients (with AF); sustained and clinical VT was induced in 10 patients with a left ventricular ejection fraction > 0.40, except in one patient. Valvular prothesis and coronary bypass graftings were normal. In all patients, HRV was normal before surgery and decreased after cardiac surgery; before versus after surgery, respectively, HR 69 +/- 9 and 89 +/- 30 beats/min (P < 0.01), SDNN 117 +/- 31 and 50 +/- 11 ms (P < 0.001), low frequency (LF) 474 +/- 658 and 51 +/- 40 ms2 (P < 0.05), high frequency (HF) 115 +/- 23 and 33 +/- 32 ms2 (P < 0.05), LF:HF 4 +/- 3 and 1 +/- 0.6 (P < 0.01). Follow-up lasted from 6 months to 10 years (mean 3 +/- 2 years). In patients without induced VT, 1 patient died from asystole, 1 had an ICD but no subsequent events, and the other 4 untreated patients are free of events. Patients with induced VT were treated with amiodarone and beta-blockers except in one patient who died from extracardiac complications. Six of nine patients had no inducible VT with this treatment and are alive; 3 patients had inducible VT, 1 died suddenly before implantation of ICD, and 2 patients are alive with an ICD; recurrent VTs were noted in one patient and received an ICD. In conclusion, recent heart surgery may increase the risk of ventricular arrhythmias. The reduction of indexes reflecting sympathetic and parasympathetic tone could facilitate the occurrence of atrial arrhythmias (and then VT) in patients without ventricular arrhythmogenic substrate or the development of VT/VF in patients with a latent previous ventricular arrhythmogenic substrate. In patients without inducible VT, the prognosis is excellent and an ICD is not recommended in these patients. In those with inducible VT, there is a high incidence of responders to antiarrhythmic drugs with a favorable prognosis.

show abstract

De novo monomorphic and polymorphic ventricular tachycardia following coronary artery bypass grafting

Cited by 24 publications

References 12 publications

Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials

Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials

Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery

Postoperative Ventricular Arrhythmias after Cardiac Surgery:

Contact Info

Product

Resources

About