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Prolonged bradyarrhythmias after isolated coronary artery bypass graft surgery
G Emlein1, S K Huang, L A Pires
1Department of Internal Medicine, University of Massachusetts Medical Center, Worcester 01655.
Insights
Older age, left bundle branch block, and LV aneurysmectomy predict bradyarrhythmias after coronary artery bypass graft (CABG) surgery, necessitating pacemakers.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Bradyarrhythmias requiring pacemakers are a rare but serious complication after coronary artery bypass graft (CABG) surgery.
- Identifying predictive factors is crucial for risk stratification and patient management.
Purpose of the Study:
- To identify preoperative clinical and electrocardiographic (ECG) characteristics that predict the occurrence of severe, prolonged bradyarrhythmias following isolated CABG surgery.
Main Methods:
- Retrospective review of 1614 patients undergoing isolated CABG.
- Comparison of 13 patients with prolonged postoperative bradyarrhythmias (Group A) against 490 controls without bradyarrhythmias (Group B).
- Analysis of preoperative clinical data and ECGs, including multivariate analysis.
Main Results:
- Patients with bradyarrhythmias were older (mean 69.2 vs 62.8 years), had more LV aneurysmectomies, and less internal mammary grafts.
- Preoperative complete left bundle branch block (LBBB) was significantly more frequent in Group A (p < 0.0001).
- Multivariate analysis identified LBBB, LV aneurysmectomy, and age > 64 as independent predictors of severe bradyarrhythmias.
Conclusions:
- Preoperative LBBB, concomitant LV aneurysmectomy, and older age (>64 years) are independent predictors of severe postoperative bradyarrhythmias after CABG.
- These findings aid in identifying high-risk patients who may benefit from closer monitoring or alternative strategies.
Abstract:
To evaluate clinical and electrocardiographic (ECG) characteristics that may predict the occurrence of bradyarrhythmias after isolated coronary artery bypass graft (CABG) surgery, 1614 consecutive patients who had this procedure performed at our institution from January 1988 to December 1990 were reviewed. Thirteen (0.8%, 7 males and 6 females) patients had prolonged (mean 10.5 +/- 6.5 days) postoperative bradyarrhythmias and required insertion of a permanent pacemaker. Complete heart block occurred in eight patients and sinus node dysfunction in five. These 13 patients (group A) were compared with a group of 490 arbitrarily selected CABG patients (group B) without bradyarrhythmias whose preoperative ECGs were reviewed. Patients in group A were older (mean 69.2 vs 62.8 years; p = 0.0004) and had concomitant left ventricular (LV) aneurysmectomy more frequently (p = 0.02) and internal mammary graft revascularization less frequently (p = 0.022) than group B patients. Review of preoperative ECGs revealed a higher occurrence of complete left bundle branch block (LBBB) (5 of 13 vs 6 of 490; p < 0.0001) and a borderline, more leftward frontal plane QRS axis (-5.3 vs 13.1 degrees, p = 0.068) in group A patients. There were no differences between the groups with respect to gender, number of bypass grafts, location of prior myocardial infarction, and preoperative ECG intervals (PR, QRS, QTc). Multivariate analysis identified the presence of a preoperative LBBB, concomitant LV aneurysmectomy and age > 64 years as independent predictors of severe and prolonged postoperative bradyarrhythmias, mainly complete heart block.(ABSTRACT TRUNCATED AT 250 WORDS)