New-Onset Ventricular Arrhythmias in Patients with Left Ventricular Dysfunction after Coronary Surgery: Incidence, Risk Factors, and Prognosis
DOI:
https://doi.org/10.1532/hsf.1944Keywords:
coronary artery bypass grafting, ventricular tachycardia, ventricular fibrillation, ejection fractionAbstract
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.
References
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.
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).
