Patterns of perioperative arrhythmias in adult cardiac surgery: A single center study from Sri Lanka

Abstract

Introduction: There is no published data on perioperative arrhythmias in adults undergoing cardiac surgery in Sri Lanka. The object of this study was to assess the patterns of peri operative arrhythmias in cardiac surgical patients. Methods and material: This is a prospective descriptive study of 100 patients in a single cardiothoracic unit in a tertiary care hospital in Sri Lanka from November 2018 to May 2020. Demographic data and clinical data were assessed in all patients. Furthermore, 24-hour Mobile Cardiac Outpatient Telemetry MCOT was assessed in a subset of patients. Results: There were 72 males and 28 females. The mean age was 60 (range 37-76 years). The majority (76) had undergone isolated coronary artery bypass grafting (CABG). The mortality was 3.5% in routine and 15% in urgent and emergency operations. Arrhythmias where lowest preoperatively (11%). Arterial fibrillation (AF) (6%) and sinus bradycardia (4%) were the commonest arrhythmias seen preoperatively. Arrhythmias were higher during surgery (29%) and ventricular fibrillation (VF) (25%) was the commonest. Arrhythmias were highest post operatively (34%) and (AF) (12%) was the commonest followed by sinus tachycardia (9%). The higher incidence of arrhythmias in the in-hospital postoperative period as compared to the preoperative period was significant (p=0.0001). A limited in-depth study using a mobile cardiac telemetry (MCOT) device showed a higher incidence of AF preoperatively (11%) and postoperatively (16%) but these differences were not significant when compared with that of routine investigations (p=0.18 and p=0.35 respectively). However, the MCOT detected some arrhythmias completely missed by routine ECG recordings, notably supraventricular tachycardia, both preoperatively (22%) and postoperatively (33%). Conclusions: This study has established baseline values of perioperative arrhythmias in the adult cardiac surgical patients in Sri Lanka. The MCOT methodology shows the potential for a more detailed study of arrhythmias and could inform decision-making in arrhythmia prophylaxis.