[Non-cardiac surgery for patients with arrhythmia]

Area of Science:

• Cardiology
• Anesthesiology
• Perioperative Medicine

Background:

• Arrhythmia is the most frequent cardiac complication during noncardiac surgery.
• While often benign, perioperative arrhythmias can be fatal and necessitate emergency intervention.
• Arrhythmias manifest as tachycardia or bradycardia, both potentially leading to cardiac failure.

Purpose of the Study:

• To review the common causes and types of perioperative arrhythmias.
• To highlight the impact of pre-existing cardiac conditions and physiological disturbances on arrhythmia development.
• To address the specific challenges posed by pacemakers and implantable cardioverter-defibrillators (ICDs) during surgery.

Main Methods:

• Literature review of perioperative cardiac complications.
• Categorization of arrhythmias based on heart rate (tachycardia and bradycardia).
• Analysis of etiological factors including ischemic heart disease, hypertensive heart disease, valvular heart disease, and non-cardiac causes like hypoxia and electrolyte imbalance.

Main Results:

• Ischemic heart disease is linked to premature ventricular contractions and ventricular tachycardia.
• Hypertensive or valvular heart disease can precipitate atrial fibrillation and supraventricular tachycardia.
• Non-cardiac factors (hypoxia, hypovolemia, electrolyte disturbance, acidosis, hypothermia) and surgical electrocautery affecting pacemakers/ICDs are significant contributors.

Conclusions:

• Perioperative arrhythmias are multifactorial, stemming from cardiac conditions, physiological derangements, and device interference.
• Management requires awareness of underlying causes and potential complications, especially for patients with cardiac devices.
• Resetting pacemaker and ICD modes during surgery is essential if electrocautery interference occurs.