Arrhythmias and conduction disturbances following aortic valve implantation

In the first postoperative week following aortic valve implantation, arrhythmias and conduction disturbances were seen in 37 of 44 patients studied. Sixty-seven episodes of arrhythmias occurred, atrial fibrillation and accelerated junctional rhythms accounted for more than 75% of these episodes. Episodes of atrial fibrillation were most common after the age of sixty.l When atrial premature contractions were observed, episodes of atrial fibrillation followed shortly afterwards. Accelerated junctional rhythms were seen in 17 patients and affected the patients haemodynamically when this dysrhythmia occurred early in the postoperative course, but improvements were seen promptly following atrial overpacing. Lidocaine was infused prophylactically for 2 days in patients with severe aortic stenosis or marked left ventricular hypertrophy. One episode of ventricular fibrillation and few incidents of ventricular extrasystoles were seen. Most conduction disturbances were transient, but bundle branch block persisted in 3 patients, and there was complete A-V block in a fourth. No causal relationship between the use of digitoxin and the frequency of arrhythmias could be established.