CLINICAL RESEARCH: ELECTROPHYSIOLOGY
Predictors of new malignant ventricular arrhythmias after coronary surgery
A case-control study
Raimondo Ascione, MD, MCh*,*,
Barnaby C. Reeves, PhD*,
Kirkpatrick Santo, FRCS*,
Nouman Khan, FRCS* and
Gianni D. Angelini, MD, MCh, FRCS*
* 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.
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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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