The incidence and outcome of ventricular arrhythmias after noncardiac thoracic surgery Journal Article

  


Authors: Amar, D.; Zhang, H.; Roistacher, N.
Article Title: The incidence and outcome of ventricular arrhythmias after noncardiac thoracic surgery
Abstract: Atrial arrhythmias are common after thoracic surgery, but the incidence and significance of ventricular arrhythmias early after such surgery are not well established. Our goal was to determine the incidence and outcome of this complication from a continuing prospective database in 412 patients who had lobectomy (n = 243) or pneumonectomy (n = 169) and were continuously monitored with Holter recorders for 72-96 h postoperatively. The primary end point of the study was the occurrence of ventricular tachycardia (VT) defined as three or more consecutive wide complexes. Sixty-one of 412 patients (15%) developed 1 or more episode of VT. There were no episodes of sustained (>30 s) VT and no patient required treatment for hemodynamic compromise associated with any VT episode. Patients with VT had a more frequent incidence of a preoperative left bundle branch block (P = 0.01) but did not differ in other clinical characteristics, operative data, or core temperature on arrival to the postanesthesia care unit, when compared with those without VT. Patients who developed VT had significantly more atrial premature contractions (P < 0.001), ventricular premature contractions (P < 0.001), ventricular couplets (P < 0.001), and postoperative atrial fibrillation, 21 of 61 (34%) versus 58 of 351 (17%), P = 0.001, than those without VT, respectively. Multivariate logistic regression analysis revealed that only postoperative atrial fibrillation occurrence was independently associated with VT (relative risk 2.6, 95% confidence intervals 1.4 to 4.8, P = 0.002). We conclude that nonsustained VT after noncardiac thoracic surgery occurs frequently but is not associated with poor outcome. The strong association of atrial and ventricular arrhythmogenesis with VT suggests that vagal withdrawal and/or adrenergic hyperactivity may have a role in precipitating these events in the early postoperative period.
Keywords: adult; treatment outcome; aged; middle aged; major clinical study; postoperative period; lung resection; incidence; data base; confidence interval; statistical significance; preoperative period; multivariate logistic regression analysis; databases, factual; hemodynamic monitoring; thorax surgery; lobectomy; heart atrium fibrillation; atrial fibrillation; heart; heart ventricle arrhythmia; heart ventricle tachycardia; tachycardia, ventricular; heart surgery; heart ventricles; thoracic surgical procedures; heart rate; autonomic nervous system; myocardial ischemia; holter monitoring; anesthesia mechanism; arrhythmia; heart ventricle extrasystole; humans; human; male; female; priority journal; article; electrocardiography, ambulatory; heart left bundle branch block
Journal Title: Anesthesia and Analgesia
Volume: 95
Issue: 3
ISSN: 0003-2999
Publisher: Lippincott Williams & Wilkins  
Date Published: 2002-09-01
Start Page: 537
End Page: 543
Language: English
PUBMED: 12198031
PROVIDER: scopus
DOI: 10.1213/00000539-200209000-00006
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-0036712975&partnerID=40&md5=abeefe6dfae20f7f6131267f13c63923
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Nancy Roistacher
    38 Roistacher
  2. David Amar
    137 Amar
  3. Hao Zhang
    62 Zhang
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