Retrosternal hematoma causing torsade de pointes after coronary artery bypass graft surgery; a case report

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Myocardial infarction (MI) is a leading cause of global mortality, with survivors facing potential complications.
• Coronary artery bypass graft (CABG) surgery is a common treatment for MI, but carries risks of early and late complications.
• Ventricular tachyarrhythmias, such as torsade de pointes (TdP), are potentially lethal complications of CABG due to electrical inhomogeneity.

Observation:

• A rare case of medically intractable TdP occurred in a patient post-CABG.
• This TdP was associated with an uncommon retrosternal hematoma.
• The arrhythmia resolved completely after surgical removal of the hematoma.

Findings:

• The case suggests a potential cause-and-effect relationship between post-CABG retrosternal hematoma and medically-resistant TdP.
• Mechanical pressure from the hematoma may trigger TdP, even without electrolyte imbalances or ongoing ischemia.
• This highlights a unique mechanism for TdP in the post-cardiac surgery setting.

Implications:

• This case underscores the importance of considering mechanical etiologies for refractory arrhythmias after CABG.
• Surgical intervention for retrosternal hematoma may be crucial in managing TdP unresponsive to standard medical therapy.
• Further investigation into the mechanical-ischemic interplay in post-CABG arrhythmias is warranted.