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[Prognostic value and development of late potentials after aortocoronary bypass. A prospective study of 100 patients]
Insights
Late ventricular potentials (LVPs) after coronary bypass surgery are not strong predictors of sudden cardiac death. Revascularization may improve outcomes, overriding the arrhythmogenic substrate indicated by LVPs.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Context:
- Ventricular late potentials (LVPs) are recognized post-infarction risk markers for ventricular tachycardia and sudden cardiac death.
- Coronary bypass surgery (CBS) aims to improve myocardial perfusion and reduce cardiac events.
Purpose:
- To assess the prognostic value and evolution of LVPs after CBS.
- To evaluate the impact of CBS on the arrhythmogenic substrate indicated by LVPs.
Summary:
- LVPs were present in 17/100 patients pre-CBS, associated with lower ejection fraction.
- Post-CBS, LVPs persisted in 6 patients, appearing in 5 new cases, often linked to perioperative myocardial infarction.
- LVPs correlated with ventricular extrasystoles, but all patients with LVPs survived the 40-month follow-up.
Impact:
- LVPs persist in a significant proportion of patients post-CBS, but their prognostic significance appears diminished.
- The favorable survival rates suggest revascularization's benefits may outweigh the arrhythmogenic substrate.
- Further research is needed to clarify the role of LVPs in risk stratification post-revascularization.
Abstract:
Ventricular late potentials are post-infarction markers of the risk of ventricular tachycardia and sudden death. In order to assess their prognostic value and evolution after coronary bypass surgery, 100 patients underwent signal-averaged electrocardiographic recordings 24 hours before and 9 days after surgery, and were then prospectively followed up for 40 +/- 8 months. Patients who displayed late ventricular potentials underwent an additional recording at 5 months with 24 hour Holter monitoring. The average age of the patients was 57.0 +/- 8.4 years; 55 had previous myocardial infarction; 32 had triple vessel disease; the mean left ventricular ejection fraction was 59.7 +/- 12.4%. Ventricular late potentials were recorded in 17 patients before surgery and their left ventricular ejection fraction was significantly lower (51.4 +/- 11.5% vs 61.4 +/- 11.9%: p less than 0.05). There was one operative death in a patient with late ventricular potentials. After surgery, late ventricular potentials were only recorded in 6 patients: at the 9th postoperative day in 3 cases and at the 5th postoperative day in 3 cases. Ventricular late potentials appeared postoperatively in 5 patients, 4 of whom had suffered perioperative myocardial infarction. The recordings became normal at the 5th month in 2 of these 5 patients. Holter monitoring at the 5th month compared with a control group, showed a significant correlation between left ventricular potentials and frequent repetitive or polymorphic ventricular extrasystoles. The 40 month survival rate was excellent: 2 patients were lost to follow-up; there were 3 cardiac deaths, one of which was sudden and 4 non-cardiac deaths. All patients with late ventricular potentials were still alive. These results show that late ventricular potentials persist after coronary bypass surgery in 2/3 of patients; their prognostic significance is not obvious. The low incidence of postoperative sudden death could be attributed to the favourable overall effects of revascularisation rather than on the arrhythmogenic substrate.