Prognosis of patients with frequent premature ventricular complexes and nonsustained ventricular tachycardia after coronary artery bypass graft surgery

Abstract

Background: Previous studies in small groups of predominantly nongeriatic patients showed that complè ventricular arrhythmias occurring after coronary artery graft (CABG) surgery are of no prognostic significance. The purpose of this study was to compare the prognosis of patients with and without advanced grade ventricular arrhythmias (AGVA) after CABG in a large group of patients. [In this paper, AGVA is used as an abridged definition of frequent premature ventricular complexes (PVCs) and nonsustained ventricular tachycardia (NSVT) which represent advanced grade ventricular arrhythmias.] Methods: Twenty‐four hour ambulatory electrocardiographic (ECG) monitoring was performed 3 days after CABG in 185 consecutive patients with and 185 closely matched control patients without AGVA. Of 185 patients with AGVA, 77 had frequent PVCs, 45 had NSVT, and 63 patients had both. The average age of both groups was 65 ± 9.7 years. Patients were followed for 34 ± 10 months, and in 30 patients ambulatory monitoring was repeated at the end of the follow‐up. Results: Fifteen AGVA and nine control patients died. In each group seven deaths were noncardiac. Six nonsudden and two sudden cardiac deaths (SCD) occurred in the AGVA group at 2‐36 months after CABG and two nonsudden cardiac deaths in the control group at 3 and 35 months after CABG (p = 0.053). Both SCDs occurred 33 months after CABG after new events known to predispose to SCD. In 18 of 30 patients AGVÀ was no longer present when ambulatory ECG monitoring was repeated 36 ± 11 months after CABG. Conclusions: AGVA after CABG was not a marker of an early sudden cardiac death. In 60% of patients not treated with antiarrhythmic drugs, AGVA was no longer present late after operation.

Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery

“…VT carries a high mortality risk, both during the acute phase and after hospital discharge [6][7][8][9][10]. On the other hand, nonsustained ventricular tachycardia does not seem to represent an ominous sign for the postoperative prognosis of surgically revascularized patients [15].…”

Arrhythmias Post Coronary Artery Bypass Surgery

“…On the contrary, frequent PVCs (>30 per hour) may reduce ventricular function and therefore have an adverse impact on the short-term outcome. There was no significant difference in mortality in patients with versus patients without frequent postoperative PVCs and NSVT (8 versus 5%), at an average follow-up of 3 years, in a study including 185 postoperative patients [137]. However, in another study of 126 patients with postoperative PVCs, it was shown that patients with left ventricular ejection fraction (LVEF) of <40% had a 75% mortality rate and 33% incidence of sudden death at an average followup of 15 months, whereas none of the patients with preserved left ventricular function had sudden death [135].…”

Postoperative Arrhythmias after Cardiac Surgery: Incidence, Risk Factors, and Therapeutic Management

“…On the other hand, frequent PVCs (>30 per hour) may have an impact on short-term outcome by reducing ventricular function. A study [138] of 185 patients reported no significant differences in mortality rates at an average followup of 3 years in patients with versus patients without frequent postoperative PVCs and nonsustained ventricular tachycardia (NSVT) (8% versus 5%). However, another study [139] of 126 patients with postoperative complex ventricular ectopies showed that patients with impaired left ventricular ejection fraction (<40%) had a 75% mortality rate and 33% incidence of sudden death at an average followup of 15 months, whereas none of the patients with preserved left ventricular function had sudden death.…”

“…Among patients who survive in-hospital sustained ventricular arrhythmias, up to 40% have a recurrence. As many as 20% of these patients die from cardiac causes within 24 months [137, 138]. …”