Abstract

M. IGLESIAS, Ricardo et al. Arritmia ventricular en el postoperatorio inmediato de cirugía cardiovascular. Rev. costarric. cardiol [online]. 2004, vol.6, n.2, pp.29-35. ISSN 1409-4142.

Objective: Determine the incidence, related factors and in-hospital evolution of the malignant ventricular arrhythmias in the early postoperative period of cardiac surgery. Method:The first 96 hours of the postoperative period of cardiac surgery were analyzed in 355 consecutive patients. Non sustained ventricular tachycardia,sustained ventricular tachycardia and ventricular fibrillation were considered as malignant arrhythmias. Preoperative, intraoperative and postoperative predisposing factors were registered, as well as in-hospital evolution. Results: Myocardial revascularization was performed in 273 patients (77%),valvular surgery in 74 patients (21%) and combined procedures in 8 patients (2%). Twenty five patients presented malignant arrhythmias (7%), Non sustained ventricular tachycardia was detected in 7 patients (28%), sustained ventricular tachycardia SVT in 11 patients (44%), Ventricular Fibrillation in 7 patients (28%). Malignant arrhythmias were more frequent in revascularization surgery (9.1%vs.0%;p<0,005), for inotropics use (64%vs.34%; p<0,005)or for ischemia or perioperative infarction (48% vs.16%;p<0.0001).The pump time was longer in patients with malignant arrhythmias (142.4 ±45.1 min.vs.106,3 ±30,1 min.;p<0,0005).The independent risk variables were: myocardial revascularization (Odds Ratio 7.52), use of inotropics (Odds Ratio 2,63)and increased pump time (Odds Ratio 1,02).Only 03.5%of malignant arrhythmias did not present leading factors. Mortality with malignant arrhythmias was 52%,and 5%(p<0,001)without.Mortality for all causes was 14%in non sustained ventricular tachycardia, 45% in sustained ventricular tachycardia and 100% in Ventricular Fibrillation. Recurrence and refractivity to antiarrhythmics were observed in patients with SVT. Malignant arrhythmias is a high mortality complication, related to intraoperative factors in coronary artery surgery.

Keywords : Coronary disease; Revascularization; Tachyarrhythmias.