Exacerbation of ventricular arrhythmias during the postoperative period after implantation of an automatic defibrillator

Departmnentof Medicine, Montefiore Medical Center/Moses Division, Bronx, New York 10467.

The postoperative course of 68 consecutive patients treated with an implantable defibrillator during the period from 1982 through 1990 was studied. In 46 patients (group 1), no concomitant surgery was performed during the implantation. In 22 patients (group 2), concomitant surgery (coronary artery bypass [n = 12], valve replacement [n = 3] or arrhythmia surgery [n = 7]) was performed. All patients in group 1 were clinically stable before surgery, receiving an antiarrhythmic regimen chosen by serial drug testings. The same regimen was continued postoperatively. Eight of the 46 patients in group 1 whose condition had been stable in the hospital for 19 +/- 25 days preoperatively developed multiple episodes of sustained ventricular tachycardia 4 +/- 9 days after implantation while receiving the same antiarrhythmic regimen. Although the exacerbation was transient in some patients, six required different antiarrhythmic therapy and one eventually died. Two additional patients had frequent and prolonged episodes of nonsustained ventricular tachycardia that could trigger the defibrillator, requiring changes in the antiarrhythmic regimen. Another patient had progressive cardiac failure and died on day 5. A marked (sevenfold) increase in asymptomatic ventricular arrhythmias was noted in 42% of the remaining 35 patients. In group 2 (combined surgery), one patient developed refractory ventricular tachycardia 3 days postoperatively and died on that day. Three patients developed frequent nonsustained ventricular tachycardia postoperatively, requiring changes in the antiarrhythmic regimen. The overall surgical mortality rate was 4.4% (4.3% in group 1 and 4.5% in group 2) and was due to refractory ventricular tachycardia in two patients and cardiac failure in one.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				L. A. Pires, M. H. Lehmann, R. T. Steinman, J. J. Baga, C. D. Schuger, and Participating Investigators Sudden death in implantable cardioverter-defibrillator recipients: clinical context, arrhythmic events and device responses J. Am. Coll. Cardiol., January 1, 1999; 33(1): 24 - 32. [Abstract] [Full Text] [PDF]

				R. Ruppel, C. A. Schluter, S. Boczor, T. Meinertz, M. Schluter, K.-H. Kuck, and R. Cappato Ventricular tachycardia during follow-up in patients resuscitated from ventricular fibrillation: experience from stored electrograms of implantable cardioverter-defibrillators J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1724 - 1730. [Abstract] [Full Text] [PDF]

				S. L. Pinski and G. J. Fahy The Proarrhythmic Potential of Implantable Cardioverter-Defibrillators Circulation, September 15, 1995; 92(6): 1651 - 1664. [Abstract] [Full Text]

				M. A. Wood, P. M. Simpson, B. S. Stambler, J. M. Herre, R. C. Bernstein, and K. A. Ellenbogen Long-term Temporal Patterns of Ventricular Tachyarrhythmias Circulation, May 1, 1995; 91(9): 2371 - 2377. [Abstract] [Full Text]

				S. O. Nunain, M. Roelke, T. Trouton, S. Osswald, Y. H. Kim, G. Sosa-Suarez, D. R. Brooks, B. McGovern, M. Guy, D. F. Torchiana, et al. Limitations and Late Complications of Third-Generation Automatic Cardioverter-Defibrillators Circulation, April 15, 1995; 91(8): 2204 - 2213. [Abstract] [Full Text]

				E. U. Alt, P. C. Fotuhi, R. L. Callihan, D. L. Rollins, E. Mestre, M. P. Combs, W. M. Smith, and R. E. Ideker Improved Defibrillation Threshold With a New Epicardial Carbon Electrode Compared With a Standard Epicardial Titanium Patch Circulation, January 15, 1995; 91(2): 445 - 450. [Abstract] [Full Text]