Postoperative Cardiac Arrhythmias: Prevention and Management

Abstract

Supraventricular arrhythmias or supraventricular tachy cardias (SVT) frequently occur after thoracic surgery and have been associated with prolonged hospital stays. The reported incidence of supraventricular ar rhythmias in this patient population ranges from 9% to 40%, with factors such as extent of surgery markedly influencing the incidence. SVT has been reported to be 12% to 16% after lobectomy, 20% to 30% after pneumo nectomy, and as much as 40% after extrapleural pneu monectomy for malignant pleural mesothelioma. Pa tients who develop SVT have a higher rate of intensive care unit admission and higher 30-day mortality. SVT occurrence appears to be an important marker of poor cardiopulmonary reserve in patients who developed significant morbidity after thoracic surgery. It is pos sible that the rate of SVT occurrence increases propor tionally with extent of neural trauma to cardiac plexus structures in older patients. The timing of SVT onset is likely related to the high adrenergic activity of the postsurgery state and the resolution of a graded inflam matory process corresponding to the amount of blunt or sharp surgical trauma to sympathovagal nerve fibers innervating the sinus node. This article will focus on new issues leading to improved understanding of the pathophysiology and mechanisms of SVT after surgery. New approaches directed at prophylaxis and acute therapy of SVT are also discussed.