Perioperative arrhythmia associated with aortic valve stenosis

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Peri-operative arrhythmia is a significant complication in patients with aortic stenosis undergoing valve replacement surgery.
• Risk factors for arrhythmia include impaired left ventricular function and digitalis therapy.

Purpose of the Study:

• To investigate the incidence and risk factors of peri-operative arrhythmia in patients with aortic stenosis undergoing valve replacement.
• To evaluate the efficacy of lidocaine and mexiletine in preventing and treating these arrhythmias.

Main Methods:

• Retrospective study of 58 patients with sinus rhythm undergoing valve replacement.
• Continuous hemodynamic monitoring and Holter ECG recording from anesthesia induction to recovery room.
• Administration of lidocaine or mexiletine infusion for 24 hours post-cardiopulmonary bypass.

Main Results:

• Pre-bypass incidence of serious ventricular premature beats (VPBs) was 19%, increasing to 33% post-bypass (p < 0.03).
• VPBs were associated with impaired left ventricular function and preoperative digitalis therapy.
• Lidocaine and mexiletine showed identical incidences of arrhythmia, and post-bypass VPBs increased despite antiarrhythmic therapy.

Conclusions:

• Valve replacement surgery in aortic stenosis patients is associated with a significant increase in post-bypass ventricular arrhythmia.
• Class IB antiarrhythmic drugs may not be the optimal therapeutic approach for these patients.
• Further research is needed to identify the underlying causes and optimal management strategies for post-bypass arrhythmia.