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Published on: May 28, 2019
Ischemic preconditioning suppresses ventricular tachyarrhythmias after myocardial revascularization
Zhong-Kai Wu1, Tiina Iivainen, Erkki Pehkonen
1Division of Cardiac Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland.
Insights
Ischemic preconditioning (IP) effectively reduces life-threatening ventricular fibrillation (VF) and tachycardia (VT) after coronary artery bypass grafting (CABG). This study demonstrates IP
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Ischemic Preconditioning
Background:
- Ventricular fibrillation (VF) and ventricular tachycardia (VT) are critical complications post-coronary artery bypass grafting (CABG).
- Ischemic preconditioning (IP) is known to reduce ischemia-reperfusion arrhythmias in experimental and human studies.
- The efficacy of IP in preventing postoperative VF/VT in CABG patients remained uninvestigated.
Purpose of the Study:
- To evaluate the effectiveness of ischemic preconditioning (IP) in suppressing ventricular fibrillation (VF) and ventricular tachycardia (VT) in patients undergoing coronary artery bypass grafting (CABG).
- To assess the impact of IP on the duration and frequency of VF/VT episodes post-CABG.
- To determine if IP influences mechanical ventilation duration and inotrope requirements after CABG.
Main Methods:
- Eighty-six patients with 3-vessel disease undergoing CABG were randomized into an IP group or a control group.
- The IP group received two cycles of 2-minute ischemia followed by 3-minute reperfusion before the main procedure.
- Twenty-four-hour electrocardiographic monitoring was performed, and clinical outcomes were recorded.
Main Results:
- IP significantly reduced the incidence of VF after declamping (48.8% vs. 79.1%, P=0.004) and shortened the VF duration (2.28 min vs. 4.41 min, P=0.002).
- Episodes of VT were significantly decreased in the IP group during early and 24-hour reperfusion (P=0.000 and P=0.002, respectively).
- No de novo sustained VT occurred in the IP group post-surgery, compared to 3 control patients; IP also reduced ventilation time and inotrope use.
Conclusions:
- Ischemic preconditioning (IP) demonstrates significant efficacy in reducing postoperative ventricular fibrillation/tachycardia (VF/VT) in CABG patients with 3-vessel disease.
- The suppression of VT during early and delayed reperfusion phases suggests both immediate and sustained protective effects of IP.
- IP may offer a protective strategy against arrhythmias and improve recovery outcomes in patients undergoing CABG surgery.
Background:
Ventricular fibrillation (VF) and tachycardia (VT) are the common and potential life-threatening complications after CABG. Ischemic preconditioning (IP) has been proved effective in reducing ischemia reperfusion arrhythmia in animals and humans. Whether IP is effective in suppressing postoperative VF/VT in patients with CABG has not been studied.
Methods And Results:
Eighty-six patients with CABG with stable and unstable 3-vessel disease were equally randomly assigned into an IP and a control group. The patients who received IP received 2 periods of 2-minute ischemia followed by 3-minute reperfusion. Twenty-four-hour electrocardiographic data were collected. IP resulted in fewer cases of VF after declamping (48.8% versus 79.1% in IP and control, P=0.004) and a shorter VF period (2.28+/-0.44 versus 4.41+/-0.51 minutes, P=0.002). The episodes of VT were significantly reduced in patients in the IP group during early reperfusion and 24 hours after reperfusion (0.65+/-0.16 versus 3.71+/-0.46, P=0.000 and 0.07+/-0.04 versus 2.12+/-1.41, P=0.002, respectively). De novo sustained VT occurred in 3 control patients as against none in the IP group after surgery. As a result, IP significantly curtailed the mechanical ventilation period and reduced the need for inotropes.
Conclusions:
IP significantly reduced postoperative VF/VT in patients with CABG with 3-vessel disease. Suppression of VT during early reperfusion and 24 hours after reperfusion suggests early and delayed IP phenomena in patients undergoing CABG surgery.
