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Unexpected, sustained ventricular tachyarrhythmia after cardiac operations.
S K Tam1, J M Miller, L H Edmunds
1Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia 19104.
The Journal of Thoracic and Cardiovascular Surgery
|December 11, 1991
Summary
Unexpected ventricular tachyarrhythmia after heart surgery is rare but serious, often occurring in patients with pre-existing left ventricular dysfunction. Effective management requires specialized electrophysiologic studies and tailored therapies.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Unexpected sustained ventricular tachyarrhythmias can occur post-cardiac operations.
- These events must be differentiated from those with known causes like myocardial infarction or drug toxicity.
Purpose of the Study:
- To characterize unexpected sustained ventricular tachyarrhythmias following cardiac surgery.
- To evaluate the outcomes and management strategies for these arrhythmias.
Main Methods:
- Retrospective analysis of 2364 cardiac surgery patients.
- Inclusion of patients with unexpected sustained ventricular tachyarrhythmias (0.68%) occurring 1-12 days post-op.
- Electrophysiologic studies and programmed stimulation were used in survivors.
Main Results:
- 16 patients (0.68%) met criteria for unexpected sustained ventricular tachyarrhythmias.
- 12 patients experienced recurrent arrhythmias; 3 died (21%).
- All patients had preoperative left ventricular dysfunction (EF < 30% in 14).
- Initial monomorphic ventricular tachycardia was common (15/16 patients).
- Empirical therapy was often ineffective; programmed stimulation identified inducibility in 10/13 survivors.
- Successful management included antiarrhythmic drugs (9 patients), implantable cardioverter-defibrillators (3 patients), and catheter ablation (1 patient).
Conclusions:
- Unexpected sustained ventricular tachyarrhythmias post-cardiac surgery are associated with significant mortality.
- Preoperative left ventricular dysfunction is a key risk factor.
- Programmed electrical stimulation and targeted therapies are crucial for managing these arrhythmias and preventing recurrence.