Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery

Abstract

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.

Implantable cardioverter defibrillator and cardiac resynchronization treatment in people with type 2 diabetes: a comparison with age- and sex matched controls from the general population

“…Accordingly, the need for ICD, CRT-P or CRT-D treatment was higher in patients with T2DM compared to controls during follow up. The current results are in line with previous investigations showing that serious ventricular tachyarrhythmias (VT and VF) are more common in individuals with DM compared to those without DM [ 4 , 18 , 19 ]. This study further showed that patients with T2DM have a higher need for CIED and that in particular treatment with blood pressure and lipid-lowering therapies were associated with higher likelihood of receiving any of these devices whereas female sex was associated with less need.…”

Catheter Ablation for Electrical Storm as Polymorphic Ventricular Tachycardia in a Case with Ischemic Cardiomyopathy after Coronary Artery Bypass Graft

“…8) However, in our patient, there were no ischemia, electric disorders and post operative hemodynamic impairment immediately after operation.…”

Avaliação da expressão gênica e de polimorfismos da interleucina 6, do canal de potássio voltagem-dependente subfamília E subunidade 5 e angiotensinogênio na incidência da fibrilação atrial pós-operatória em revascularização cirúrgica do miocárdio

“…Em estudo desenvolvido por Aranki e colaboradores sugeriu-se que indivíduos do gênero masculino possuem maior risco de desenv olvimento da FAPo, devido a alterações na expressão de canais iônicos (ARANKI et al, 1996). Em nosso estudo houve maior freqüência de indivíduos do gênero masculino em ambos os grupos (GFA e GC), O índice de massa corpórea foi descrito como fator predis ponente da FAPo, devido ao aumento de tecido adiposo que constitui um fértil substrato anatômico para o desenvolvimento da FAPo, conferindo um aumento atrial e alterações na pressão intratorácica que alteram as propriedades eletrofisiológicas do átrio, aumentando a susceptibilidade ao desenvolvimento da FAPo (DUCCESCHI et al, 1999). Em nosso estudo não se constatou a associação entre o IMC e o desenvolvimento da FAPo.…”