Modulating Perioperative Ventricular Excitability

Cardiac arrhythmias are associated with significant morbidity and mortality. Ventricular arrhythmogenesis is a dynamic interplay among an arrhythmogenic substrate, myocardial electrophysiologic properties, modifying factors, and triggering factors. Imbalances in the autonomic nervous system can lead to increased myocardial excitability, which is a major contributor to the pathophysiology of ventricular tachyarrhythmias. Myocardial excitability and ventricular arrhythmogenesis are modulated perioperatively through hemodynamic and physiologic management, anesthetic agents, or regional anesthetic and surgical techniques.