EARLY VENTRICULAR TACHYARRHYTHMIAS AFTER CORONARY ARTERY BYPASS GRAFTING SURGERY: IS IT A REAL BURDEN?
E.M.J.P. Mouws, A. Yaksh, P. Knops, C. Kik, M.J.B. Van Ettinger, M. De Wijs, P. Van De Kemp, E. Boersma, A.J.J.C. Bogers, N.M.S. De Groot
Cardiology, Erasmus MC, Rotterdam, The Netherlands
Introduction: Ventriculartachyarrhythmias(VTA) have a reported incidence from 0.95% to 5% after coronary artery bypass grafting (CABG). Ventricular dysrhythmias(VD)(ventricular premature beats(VPBs), couplets (Vcouplets), runs(Vruns) on the other hand have so far not been examined. The goal of this study is to examine characteristics of VD and VTA in patients undergoing elective CABG. In addition, we determined predictive factors of VD/VTA.
Methods:Postoperative 5-day continuous rhythm registrations were obtained and analyzed. Incidences and burdens of VD/VTA were calculated. Independent predictors of ventricular arrhythmia were identified by multivariate binary logistic regression analysis.
Results:One-hundred-five patients (83 male(79%), age 65±9(42-83)years) were included. In total, 430,006VPBs, 8,032Vcouplets and 2,153Vruns were found in these patients. VPBs, Vcouplets and Vruns occurred in respectively 100%, 82.9% and 48.6% of patients, with corresponding burdens of 0.05%, 0% an 0%. Sustained VT and VF did not occur. Independent risk factors for VD included male gender, mitral valve insufficiency, hyperlipidemia and age?60years.
Conclusions:Incidences of VD are high in patients after CABG, but corresponding burdens are low. Future studies including patients with VTA are necessary to analyze the prognostic value of characteristics of VD for VTA.
Figure 1. A. Overall incidence of VPB, Vcouplet and Vrun within the patient population. B-D. Relative frequency distribution of the incidences of different types of ventricular dysrhythmia. E,F. Relative frequency distribution of the duration of VT episodes.
Univariate and multivariate analysis of risk factors
| Variable | Present (%event) | Absent (%event) | OR | 95%CI |
| Mitral insufficiency* | 40/49 (81.6) | 25/45 (55.6) | 3.56 | 1.40 - 9.0 |
| BSA?1.8m2* | 66/89 (74.2) | 7/16 (43.8) | 3.69 | 1.23 - 11.04 0.020 |
| Male gender* | 62/83 (74.7) | 11/22 (50.0) | 2.95 | 1.12 - 7.80 |
| Left ventricular dysfunction ?moderate* | 25/29 (86.2) | 47/74 (63.5) | 3.59 | 1.13 - 11.4 |
| Hyperlipidemia | 43/55 (78.2) | 28/47 (59.6) | 2.43 | 1.02 - 5.78 |
| Tricuspid insufficiency | 29/37 (78.4) | 36/57 (63.2) | 2.12 | 0.82 - 5.47 |
| Aortic insufficiency | 16/19 (84.2) | 49/75 (65.3) | 2.83 | 0.76 - 10.6 |
| Alcohol consumption | 24/30 (80.0) | 47/72 (65.3) | 2.13 | 0.77 - 5.89 |
| Mitral insufficiency* | 40/49 (81.6) | 25/45 (55.6) | 3.56 | 1.40 - 9.0 |
| BSA?1.8m2* | 66/89 (74.2) | 7/16 (43.8) | 3.69 | 1.23 - 11.04 0.020 |
| Male gender* | 62/83 (74.7) | 11/22 (50.0) | 2.95 | 1.12 - 7.80 |
| Left ventricular dysfunction ?moderate* | 25/29 (86.2) | 47/74 (63.5) | 3.59 | 1.13 - 11.4 |
| Hyperlipidemia | 43/55 (78.2) | 28/47 (59.6) | 2.43 | 1.02 - 5.78 |
| Tricuspid insufficiency | 29/37 (78.4) | 36/57 (63.2) | 2.12 | 0.82 - 5.47 |
| Aortic insufficiency | 16/19 (84.2) | 49/75 (65.3) | 2.83 | 0.76 - 10.6 |
| Alcohol consumption | 24/30 (80.0) | 47/72 (65.3) | 2.13 | 0.77 - 5.89 |
| >10VPB/h* | 66/73 (90.4) | 21/32 (65.6) | 4.94 | 1.17 - 14.36 |
| ?30VPB/h* | 53/57 (93.0) | 34/48 (70.8) | 5.46 | 1.66 - 17.97 |
| Age?60years* | 66/75 (88.0) | 21/30 (70.0) | 3.14 | 1.10 - 8.95 0.032 |
| Hyperlipidemia | 49/55 (89.1) | 35/47 (74.5) | 2.80 | 0.96 - 8.18 |
| Hyperlipidemia | 43/55 (78.2) | 28/47 (59.6) | 2.43 | 1.02 - 5.78 |
| BSA?1.8m2 | 76/89 (82.9) | 11/16 (68.8) | 2.66 | 1.79 - 8.91 |
