Treatment of life-threatening ventricular arrhythmias by a combination of β-receptor blocker and temporary right ventricular pacing in adult patients after heart operation

Abstract

Objective To retrospectively observe the efficacy of treatment of life-threatening ventricular arrhythmias by a combination of β-receptor blocker and temporary right ventricular pacing on adult cardiac disease patients after heart operation. Methods Eight patients with adult cardiac diseases occurring intractable ventricular tachycardia/ventricular fibrillation after operation from 1 week to 2 years postoperative from May 2004 to May 2016 were selected, including 2 males and 6 females, aged from 42 to 72 years, 7 patients were rheumatic heart valve disease and underwent valve replacement, 1 patient was coronary artery disease and under on pump CABG. The 6 cases were atrial fibrillation preoperatively, and 2 cases were sinus rhythm. β-receptor blocker esmolol injection was used immediately after defibrillation and combination with one or more the following drugs: amiodarone, lidocaine when malignant ventricular arrhythmia were found. The unipolar right ventricular temporary pacing was inserted when heart rate was less than 50-70 bpm and the malignant ventricular arrhythmia was not been effectively suppressed. The ventricular tachycardia or ventricular fibrillation was effectively controlled by combination with unipolar right ventricular VVI temporary pacing (pacing rate was 80-100 bpm). Patients were treated by non-invasive positive ventilation or intubated and invasively ventilated when lung function was worsen and treated by dopamine and and noradrenaline when heart function was worsen. The 24 h dynamic electrocardiogram was performed after the malignant ventricular arrhythmia were suppressed successfully viewed by bedside electrocardiogram monitor and right ventricular temporary pacer was with drew from after 24 h Holter was good. Results Eight patients all survived and discharged. Heart function wasn’t deteriorated, no patient had multiple organs failure, 24 h dynamic electrocardiogram showed premature ventricular beats were more than 1 000 beats in 1 case, and were 500-1 000 in 1 case, and less than 500 in 2 cases, and 2 times paroxysmal ventricular tachycardia in 2 cases and 3 times in 1 case. Eight cases were followed up for 2 months to 132 months. there was no recurrence of malignant ventricular arrhythmia, New York heart function grade was Ⅱ-Ⅲ in all 8 cases, 2 cases were readmitted for heart function failure at 1 year, 1 case died for non cardiac events at 1 year, 1 case died for end-stage coronary artery disease and myocardial infarction at 5 years after discharge. Conclusions Treatment of intractable life-threatening ventricular arrhythmias by a combination of β-receptor blocker and temporary right ventricular pacing in adult patients after valve replacement is safe and effectively and should be recommended. Key words: Right ventricular temporary pacing; β-receptor blocker; Adult cardiac disease; Ventricular tachycardia; Ventricular fibrillation