Perioperative Ventricular Dysrhythmias in Patients with Structural Heart Disease Undergoing Noncardiac Surgery

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…The same is often true of asymptomatic ventricular arrhythmias, even in the presence of structural heart disease. 36,37 On the other hand, subtle ECG clues can point to a clinically silent condition of major importance.…”

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia

“…In addition, the frequency of ventricular arrhythmias in the intra and postoperative period of patients with structural heart disease and repetitive forms of ventricular extrasystole (diagnosed in the preoperative evaluation) undergoing noncardiac surgery was not associated with adverse cardiovascular events 97 .…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…17,114 More recent detailed studies using continuous ECG monitoring found that asymptomatic ventricular arrhythmias, including couplets and nonsustained ventricular tachycardia, were not associated with an increase in cardiac complications after noncardiac surgery. 37 Nevertheless, the presence of an arrhythmia in the preoperative setting should provoke a search for underlying cardiopulmonary disease, ongoing myocardial ischemia or infarction, drug toxicity, or metabolic derangements.…”

“…Studies have shown that although nearly half of all high-risk patients undergoing noncardiac surgery have frequent premature ventricular contractions or asymptomatic nonsustained ventricular tachycardia, the presence of these ventricular arrhythmias is not associated with an increase in nonfatal MI or cardiac death. 36,37 Nevertheless, the presence of an arrhythmia in the preoperative setting should provoke a search for underlying cardiopulmonary disease, ongoing myocardial ischemia or infarction, drug toxicity, or metabolic derangements. Physicians should also have a low threshold at which they institute prophylactic beta-blocker therapy in Several studies have demonstrated that beta-blocker therapy can reduce the incidence of arrhythmias during the perioperative period.…”