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CLINICAL RESEARCH: ELECTROPHYSIOLOGY

Predictors of new malignant ventricular arrhythmias after coronary surgery

A case-control study

^* Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom

Manuscript received May 2, 2003; revised manuscript received October 20, 2003, accepted November 3, 2003.

^* Reprint requests and correspondence: Dr. Raimondo Ascione, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom.
R.Ascione{at}bristol.ac.uk

OBJECTIVES: We sought to investigate the relationship between perioperative factors and the occurrence of ventricular tachycardia (VT) and ventricular fibrillation (VF), as well as the impact of VT/VF on early and late mortality.

BACKGROUND: Both VT and VF are rare but serious complications after coronary artery bypass graft surgery (CABG), and their etiology and implications remain uncertain.

METHODS: Data on 4,411 consecutive patients undergoing CABG (1,154 [25.8%] had off-pump surgery) between April 1996 and September 2001 were extracted from a prospective database and analyzed. Odds ratios (ORs) describing associations between possible risk factors and VT/VF were estimated separately. Factors observed to be significantly associated with VT/VF were further investigated using multivariate logistic regression.

RESULTS: Sixty-nine patients suffered VT/VF (1.6%). There were 61 (1.4%) in-hospital/30-day deaths, 15 among patients who had postoperative VT/VF (21.7%). Patient factors independently associated with an increase in the odds of VT/VF included age <65 years, female gender, body mass index <25 kg/m², unstable angina, moderate or poor ejection fraction, and the need for inotropes and an intra-aortic balloon pump (OR 1.72 to 4.47, p < 0.05). After adjustment, off-pump surgery was associated with a substantial but nonsignificant protective effect against VT/VF (OR 0.53, 95% confidence interval [CI] 0.25 to 1.13; p = 0.10). Actuarial survival at two years was 98.2% among patients who had VT/VF and who survived to discharge/30 days, compared with 97.0% for the control group (adjusted hazard ratio 0.96 (95% CI 0.40 to 2.31, p = 0.92).

CONCLUSIONS: The incidence of VT/VF is low in patients undergoing coronary surgery but is associated with high in-hospital mortality. The late survival of the discharged VT/VF patients compares favorably with that of controls.

Abbreviations and Acronyms   BMI = body mass index   CABG = coronary artery bypass graft surgery   CI = confidence interval   EF = ejection fraction   IABP = intra-aortic balloon pump   ICD = implantable cardioverter-defibrillator   LV = left ventricular   MI = myocardial infarction   OR = odds ratio   PATS = Patient Activity Tracking System   VF = ventricular fibrillation   VT = ventricular tachycardia

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