[Relation between preoperative ventricular arrhythmias and postoperative results in aortic valve regurgitation]

Sudden death is a well known complication of aortic valve regurgitation and remains a common cause of late mortality after aortic valve replacement. Although malignant arrhythmias have been suggested as the cause of these outcome, there has been little information concerning the frequency and severity of ventricular arrhythmias in patients with aortic valve regurgitation. In order to evaluate the relation between the severity and/or frequency of ventricular arrhythmias and late postoperative results in patients with pure aortic valve regurgitation, 24-hour ambulatory electrocardiographic recordings were obtained before surgery in 107 patients without coronary artery disease. Grading of ventricular arrhythmias was based on a Lown method and compared with hemodynamic data. Ventricular premature beats were observed in 101 patients (94.4%) before operation. Multiformity was found in 10 patients (9.3%) couplets in 19 patients (17.8%) and ventricular tachycardia in 32 patients (29.9%). Patients with severe ventricular arrhythmias (Lown grade 3 or 4: 57.0%) had a higher left ventricular end systolic volume index (LVESVI) 153.1 +/- 76.4 ml/m2 vs 96.5 +/- 35.0 ml/m2 (p = 0.0001); a higher left ventricular end diastolic volume index (LVEDVI) 257.0 +/- 85.4 ml/m2 vs 206.5 +/- 58.3 ml/m2 (p = 0.0009); a lower left ventricular ejection fraction (LVEF) 43.4 +/- 12.5% vs 54.2 +/- 9.8% (p = 0.0001). LVESVI was not related to the severity of ventricular arrhythmias, but was significantly related to the frequency (p < 0.05). All patients with late death were belonging to Lown grade 3 or 4 in severity and more than 30 beats per hour in frequency (28.6%). This study indicates that ventricular arrhythmias are common in patients with aortic valve regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)