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Exacerbation of ventricular arrhythmias during the postoperative period after implantation of an automatic defibrillator. J Am Coll Cardiol 1991 Nov 01;18(5):1200-6 PMID: 1918696

Abstract

The postoperative course of 68 consecutive patients treated with an implantable defibrillator during the period from 1982 through 1990 was studied. In 46 patients (group 1), no concomitant surgery was performed during the implantation. In 22 patients (group 2), concomitant surgery (coronary artery bypass [n = 12], valve replacement [n = 3] or arrhythmia surgery [n = 7]) was performed. All patients in group 1 were clinically stable before surgery, receiving an antiarrhythmic regimen chosen by serial drug testings. The same regimen was continued postoperatively. Eight of the 46 patients in group 1 whose condition had been stable in the hospital for 19 +/- 25 days preoperatively developed multiple episodes of sustained ventricular tachycardia 4 +/- 9 days after implantation while receiving the same antiarrhythmic regimen. Although the exacerbation was transient in some patients, six required different antiarrhythmic therapy and one eventually died. Two additional patients had frequent and prolonged episodes of nonsustained ventricular tachycardia that could trigger the defibrillator, requiring changes in the antiarrhythmic regimen. Another patient had progressive cardiac failure and died on day 5. A marked (sevenfold) increase in asymptomatic ventricular arrhythmias was noted in 42% of the remaining 35 patients. In group 2 (combined surgery), one patient developed refractory ventricular tachycardia 3 days postoperatively and died on that day. Three patients developed frequent nonsustained ventricular tachycardia postoperatively, requiring changes in the antiarrhythmic regimen. The overall surgical mortality rate was 4.4% (4.3% in group 1 and 4.5% in group 2) and was due to refractory ventricular tachycardia in two patients and cardiac failure in one.(ABSTRACT TRUNCATED AT 250 WORDS)

Author List

Kim SG, Fisher JD, Furman S, Gross J, Zilo P, Roth JA, Ferrick KJ, Brodman R

Author

James A. Roth MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Anti-Arrhythmia Agents
Arrhythmias, Cardiac
Combined Modality Therapy
Coronary Artery Bypass
Electric Countershock
Electrocardiography, Ambulatory
Female
Heart Diseases
Humans
Male
Middle Aged
Postoperative Care
Postoperative Complications
Prostheses and Implants
Recurrence
Retrospective Studies
Survival Rate



View this publication's entry at the Pubmed website PMID: 1918696
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