New-Onset Ventricular Arrhythmias in Patients with Left Ventricular Dysfunction after Coronary Surgery: Incidence, Risk Factors, and Prognosis


  • Nan Cheng Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
  • Changqing Gao Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
  • Rong Wang Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
  • Ming Yang Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
  • Lin Zhang Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China



coronary artery bypass grafting, ventricular tachycardia, ventricular fibrillation, ejection fraction


Background: The incidence, risk factors, and long-term prognosis of new-onset ventricular tachycardia (VT) and ventricular fibrillation (VF) after coronary artery bypass graft surgery (CABG) in patients with impaired left ventricular function have not been thoroughly examined. 

Methods: This study enrolled 612 consecutive patients with impaired left ventricular function (ejection fraction <50%) undergoing CABG at a single institution between March, 1996, and September, 2015. Outcomes were analyzed and compared, including in-hospital mortality and long-term survival. After a propensity-score, matching was performed to adjust for differences between the two cohorts. Factors significantly associated with VT/VF were also investigated using multivariate logistic regression.

Results: Of the 600 patients included in the analyses,
92 (15.3%; 95% confidence interval [CI] 12.5–18.3%) had new-onset VT/VF postoperatively. Before propensity matching, patients with postoperative VT/VF were more likely to have renal failure, intra-aortic balloon pump support, lower preoperative ejection fraction (EF), and a larger left ventricle than those without VT/VF. Multivariate regression identified three preoperative risk factors and one protective factor that were independently associated with new-onset VT/VF: previous renal failure (odds ratio [OR] 4.42, P = .02), left ventricular end-diastolic dimension enlargement (OR 1.83,
P = .03), ejection fraction (OR 1.88, P = .02 for EF ≥30 and <40% versus ≥40% and <50%; OR 5.46, P = .00 for EF <30% versus ≥40% and <50%), and preoperative β-blockers (OR 0.58, P = .03). The median follow-up time was 46.6 months. In the propensity-matched cohorts, survival for patients who had in-hospital VT/VF was lower than that of the non-VT/VF group (89.9% versus 97.6%; P < .05).

Conclusion: This study shows a high incidence of new-onset VT/VF after CABG in patients with impaired left ventricular function. The early and long-term survival rates were significantly lower in the VT/VF group. Preoperative renal failure, left ventricular end-systolic dimension enlargement, and the severity of left ventricular function were independently associated with the development of new-onset VT/VF after CABG surgery. Preoperative use of beta-blocker was proved to be protective in reducing both VT/VF incidence and in-hospital mortality in CABG patients with impaired left ventricular function following CABG. When considering these data, a prescription of beta-blockers is prognostically indicated to CABG patients, especially those with new-onset VT/VF postoperatively.


Ascione R, Reeves BC, Santo K, et al. 2004. Predictors of new malignant ventricular arrhythmias after coronary surgery: a case-control study. J Am Coll Cardiol 43:1630-8.

Ascione R, Narayan P, Rogers CA, et al. 2003. Early and midterm clinical outcome in patients with severe left ventricular dysfunction undergoing coronary artery surgery. Ann Thorac Surg 76:793-9.

Azar RR, Berns E, Seecharran B, et al. 1997. De novo monomorphic and polymorphic ventricular tachycardia following coronary artery bypass grafting. Am J Cardiol 80:76-8.

Bigger JT, Jr., Fleiss JL, Kleiger R, et al. 1984. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation. 69:250-8.

Bonato FO, Watanabe R, Lemos MM, et al. 2016. Asymptomatic ventricular arrhythmia and clinical outcomes in chronic kidney disease: a pilot study. Cardiorenal Med 7:66-73.

Bonato FO, Lemos MM, Cassiolato JL, et al. 2013. Prevalence of ventricular arrhythmia and its associated factors in nondialyzed chronic kidney disease patients. PloS One 8:e66036.

Brembilla-Perrot B, Villemot JP, Carteaux JP, et al. 2003. Postoperative ventricular arrhythmias after cardiac surgery: immediate- and long-term significance Pacing Clin Electrophysiol 26:619-25.

Budeus M, Feindt P, Gams E, et al. 2006. Risk factors of ventricular tachyarrhythmias after coronary artery bypass grafting. Int J Cardiol 113:201-8.

Cairns JA, Connolly SJ, Roberts R, et al. 1997. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian amiodarone myocardial infarction arrhythmia trial investigators. Lancet 349:675-82.

Cheema AN, Sheu K, Parker M, et al. 1998. Nonsustained ventricular tachycardia in the setting of acute myocardial infarction: tachycardia characteristics and their prognostic implications. Circulation 98:2030-6.

Chen JW, Lin CH, Hsu RB. 2015. Malignant ventricular arrhythmias after off-pump coronary artery bypass. J Formos Med Assoc 114:936-42.

Coumel P. 1993. Cardiac arrhythmias and the autonomic nervous system. J Cardiovasc Electrophysiol 4:338-55.

Ducceschi V, D’Andrea A, Liccardo B, et al. 2000. Ventricular tachyarrhythmias following coronary surgery: predisposing factors. Int J Cardiol 73:43-8.

El-Chami MF, Sawaya FJ, Kilgo P, et al. 2012. Ventricular arrhythmia after cardiac surgery: incidence, predictors, and outcomes. J Am Coll Cardiol 60:2664-71.

Julian DG, Camm AJ, Frangin G, et al. 1997. Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. European myocardial infarct amiodarone trial investigators. Lancet 349:667-74.

Mouws EM, Yaksh A, Knops P, et al. 2017. Early ventricular tachyarrhythmias after coronary artery bypass grafting surgery: Is it a real burden? J Cardiol 70:263-70

Mozos I. 2014. Laboratory markers of ventricular arrhythmia risk in renal failure. Biomed Res Int 2014:509204.

Newby KH, Thompson T, Stebbins A, et al. 1998. Sustained ventricular arrhythmias in patients receiving thrombolytic therapy: incidence and outcomes. The GUSTO Investigators. Circulation 98:2567-73.

Pires LA, Lehmann MH, Buxton AE, et al. 2001. Multicenter unsustained tachycardia trial I. Differences in inducibility and prognosis of in-hospital versus out-of-hospital identified nonsustained ventricular tachycardia in patients with coronary artery disease: clinical and trial design implications. J Am Coll Cardiol 38:1156-62.

Smith RC, Leung JM, Keith FM, et al. 1992. Ventricular dysrhythmias in patients undergoing coronary artery bypass graft surgery: incidence, characteristics, and prognostic importance. Study of Perioperative Ischemia (SPI) Research Group. Am Heart J 123:73-81.

Steinberg JS, Gaur A, Sciacca R, et al. 1999. New-onset sustained ventricular tachycardia after cardiac surgery. Circulation 99:903-8.

Tam SK, Miller JM, Edmunds LH Jr. 1991. Unexpected, sustained ventricular tachyarrhythmia after cardiac operations. J Thorac Cardiovasc Surg 102:883-9.

Willich SN, Maclure M, Mittleman M, et al. 1993. Sudden cardiac death. Support for a role of triggering in causation. Circulation 87:1442-50.

Yeung-Lai-Wah JA, Qi A, McNeill E, et al. 2004. New-onset sustained ventricular tachycardia and fibrillation early after cardiac operations. Ann Thorac Surg 77:2083-8.



How to Cite

Cheng, N., Gao, C., Wang, R., Yang, M., & Zhang, L. (2018). New-Onset Ventricular Arrhythmias in Patients with Left Ventricular Dysfunction after Coronary Surgery: Incidence, Risk Factors, and Prognosis. The Heart Surgery Forum, 21(2), E117-E123.




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