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Transmyocardial laser revascularization and left ventricular reduction surgery affect ventricular arrhythmias and
Michael Brunner1, Barbara Hess, Georg Lutter
1Innere Medizin III-Kardiologie und Angiologie, Universitätsklinik Freiburg, Freiburg, Germany. brunner@mm31.ukl.uni-freiburg.de
Insights
Transmyocardial laser revascularization (TMLR) increases ventricular tachycardia risk in end-stage coronary artery disease patients, while left ventricular reduction (LVR) significantly impairs heart rate variability. Both procedures impact cardiac electrophysiology differently.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Transmyocardial laser revascularization (TMLR) and left ventricular reduction (LVR) are novel surgical interventions for end-stage coronary artery disease and left ventricular dilation/aneurysms.
- These high-risk procedures may influence arrhythmogenesis, necessitating an evaluation of their impact on ventricular tachyarrhythmias and heart rate variability (HRV).
Purpose of the Study:
- To assess the influence of TMLR and LVR on the incidence and severity of ventricular tachyarrhythmias.
- To evaluate the impact of these surgical procedures on time-domain heart rate variability (HRV).
Main Methods:
- A prospective study involving 37 patients undergoing either TMLR (n=23) or LVR (n=14).
- 24-hour Holter recordings were obtained preoperatively and one week postoperatively to monitor ventricular tachyarrhythmias and HRV parameters.
Main Results:
- TMLR was associated with a significant increase in spontaneous ventricular tachycardia (0% to 26%, P < .05), including one fatal ventricular fibrillation event; HRV remained unchanged.
- LVR did not significantly alter ventricular tachyarrhythmia episodes but markedly reduced all major HRV parameters (SDNN, RMSSD, pNN50) one week postoperatively.
Conclusions:
- Early TMLR may increase the risk of sudden cardiac death due to enhanced ventricular tachycardia incidence, with no significant effect on HRV.
- LVR leads to a substantial and persistent reduction in HRV one week postoperatively, without affecting ventricular tachyarrhythmia occurrence.
Background:
Transmyocardial laser revascularization (TMLR) and left ventricular reduction by endoventricular patch plasty (LVR) are 2 new surgical procedures performed in patients with endstage coronary artery disease and left ventricular dilation/aneurysms, respectively. As these are performed in patients at high risk for sudden cardiac death and may interact with arrhythmogenesis, we assessed the influence of these procedures on incidence and severity of ventricular tachyarrhythmias and time-domain heart rate variability.
Methods:
Preoperative and one week postoperative 24-hour Holter recordings were performed in 37 patients undergoing TMLR (n = 23, CO2-laser technique) or LVR (n = 14).
Results:
TMLR patients received a mean of 27.2 +/- 9.2 laser channels. Postoperatively, the proportion of patients who underwent TMLR with spontaneous ventricular tachycardia (> or =4 repetitive ventricular beats) increased (0% vs 26%, P <.05), including one patient who died from documented ventricular fibrillation during monitoring. There was no correlation to the number and/or location of laser-induced channels or to perioperative CK levels. HRV parameters were not altered by TMLR. By contrast, LVR did not significantly influence ventricular tachyarrhythmia episodes but markedly depressed all major HRV parameters (SDNN 116.4 vs 61.8, RMSSD 35.2 vs 19.9, pNN50 14.5 vs 4.9, all P <.05).
Conclusions:
Early after TMLR, there is evidence of an increased incidence of spontaneous ventricular tachycardia enhancing the risk for sudden cardiac death, while HRV remains unaffected. By contrast, LVR resulted in a marked reduction in HRV still present one week postoperatively, while no effect was observed on incidence and/or severity of spontaneous ventricular tachyarrhythmias.