Incidence Of Postoperative Ventricular Arrhythmias Research Articles

The Role of Postoperative Magnesium Infusion in Minimizing Ventricular Arrhythmia Risk after Cardiopulmonary Bypass

Introduction: Cardiopulmonary bypass increases the incidence of postoperative ventricular arrhythmias in cardiac surgery. Magnesium, which is essential for cardiac function and may prevent arrhythmias, is frequently reduced after cardiac surgery. Aim of the Study: This study aimed to investigate the preventive effects of magnesium infusion in reducing the occurrence of ventricular arrhythmias in individuals who have undergone cardiopulmonary bypass. Methods: This study, done at Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2020 to June 2022, involved 120 participants in two groups: one received magnesium sulfate following standard cardiopulmonary bypass surgery (Group A), and the other did not (Group B). Both groups were monitored in the ICU with continuous ECG tracking and assessed for ventricular arrhythmias postoperatively on days 0–3. The inclusion criteria comprised adult cardiac patients in preoperative sinus rhythm with normal magnesium levels, excluding those with a history of ventricular arrhythmias or specific medical conditions. Data collected through a questionnaire, interviews, and medical records were analyzed using SPSS version 26. Result: The mean age of the patients in Group A was 53.83±14.54 years and in Group B was 54.50 ± 10.50 years. The mean difference in postoperative Mg++ was statistically significant (p<0.05) in POD 0, POD 1, POD 2, and POD 3. In this study, there were more VA-positive patients in Group B than in Group A; 16.67% had positive ventricular arrhythmia (PVC 8.3%, VT 3.33%, VF 5.00%), while 83.33% were negative VA. Group B had 66.67% negative VA and 33.33% positive VA (PVC 15.00%, VT 10.00%, VF 8.33%). Conclusion: This study identified that the postoperative Mg infusion after cardio pulmonary bypass reduces the incidence of postoperative arrhythmias in cardiac patients. Based on the findings, we recommend using intravenous magnesium as an alternative to prevent ventricular arrhythmias after CPB in cardiac patients.

Effect of Del Nido cardioplegia on ventricular arrhythmias after cardiovascular surgery

BackgroundDel Nido cardioplegia (DNC) has been proven safe and effective in pediatric patients. However, the use of DNC in adult undergoing cardiovascular surgery lacks support with substantial evidence. This study aimed to evaluate the efficacy of DNC as a cardioplegia of prophylaxis to ventricular arrhythmias associated to cardiovascular surgery in adult patients.MethodsThis study recruited nine hundred fifty-four patients who underwent cardiopulmonary bypass surgeries in Nanjing Hospital affiliated to Nanjing Medical University between January 2019 and December 2019. Among 954 patients, 324 patients were treated with DNC (DNC group), and 630 patients were treated with St. Thomas cardioplegia (STH group). The incidence of postoperative arrhythmia as well as other cardiovascular events relavant to the surgery were investigated in both groups.ResultsIn DNC group, the incidence of postoperative ventricular arrhythmias was lower (12.4% vs. 17.4%, P = 0.040), and the length of ICU stay was shorter (1.97 ± 1.49 vs. 2.26 ± 1.46, P = 0.004). Multivariate logistic regression demonstrated that the use of DNC helped to reduce the incidence of postoperative ventricular arrhythmias (adjusted odds ratio 0.475, 95% CI 0.266–0.825, P = 0.010). The propensity score-based analysis and subgroup analysis indicated that DNC has the same protecting effects towards myocardial in all kinds of cardiopulmonary bypass surgeries.ConclusionsDel Nido cardioplegia may potentially reduce the incidence of postoperative ventricular arrhythmias, shorten the length of ICU stay and improve the overall outcome of the patients undergoing cardiovascular surgery.

Impact on the incidence of postoperative ventricular arrhythmias after cardiac resynchronization therapy defibrillator with quadripolar lead

Objective: To evaluate incidence of postoperative ventricular arrhythmias in patients who received cardiac resynchronization therapy defibrillator (CRT-D ) with left ventricular quadripolar lead. Methods: The patients received CRT-D who had complete follow-up data in Anhui Provincial Hospital from June 2013 to June 2016 were included and divided into quadripolar lead group and bipolar lead group according to the type of left ventricular lead. And ventricular arrhythmia (VA), implantable cardioverter-defibrillator (ICD) shocks treatment, antitachycardia pacing therapy (ATP), and other indicators of the two groups were compared. Prognosis of the two groups was assessed by re-hospitalization for heart failure and cardiac death. Results: Of the 220 patients enrolled in the study, 58 patients were in quadripolar lead group and 162 in bipolar lead group, and there were no significant differences in baseline characteristics between the two groups. The VA episode per patient was not significantly different between the two groups [(0.60±2.38) VA per person vs (0.93±2.24) VA per person, P=0.055]; the quadripolar lead group had significantly lower burden of VA compared with bipolar lead group [(0.22±0.91) per person-year vs (0.46±1.13) per person-year, P=0.044]. Compared with bipolar lead group, there were significant reduction in both the ICD shocks per patient and the burden of ICD shocks in quadripolar lead group: [(0.12±0.36) shocks per person vs (0.23±0.52) shocks per person, P=0.034] and [(0.04±0.17) per person-year vs (0.12±0.46) per person-year, P=0.029], respectively. There were no significant differences between the two groups in both the ATP per patient and the burden of ATP: [(1.07±3.77) ATP per person vs (1.26±3.01) ATP per person, P=0.073] and [(0.38±1.39) per person-year vs (0.63±1.48) per person-year, P=0.058], respectively. And there were no significant differences between the two groups for the survival (P=0.496). Conclusion: Compared with bipolar lead group, the burden of VA could be significantly reduced after CRT-D in the quadripolar lead group.

Normothermic versus hypothermic perfusion during primary coronary artery bypass grafting

Normothermic versus hypothermic cardiopulmonary bypass was evaluated in 1442 consecutive patients undergoing primary coronary artery bypass grafting (CABG). Group 1 ( n = 545) were operated on in moderate systemic hypothermia (rectal temperature 28 °C) and group 2 ( n = 897) in normothermia (rectal temperature 37 °C). Both groups had cold cardioplegic arrest (10 °C) and local cooling of the heart with slush. Anaesthesia and operative techniques were identical in both groups. The mean age was 60 years; group 2 contained significantly more patients aged >65 years ( P<0.05) and had more frequent emergency operations ( P<0.001) than group 1. Other preoperative patient characteristics were similar between groups. Aortic cross-clamping time was similar in both groups but cardiopulmonary bypass time was significantly longer in group 1 than in group 2 (97.9(28.8) versus 76.6(26.0) min, P<0.001), Perioperative mortality rate was 3.3% in group 1 and 2.6% in group 2. The incidence of myocardial infarction was significantly higher in group 1 than in group 2 (2.0% versus 0.7%) Perioperative low cardiac output needing inotropic support was similar in both groups, but group 1 patients required more intra-aortic balloon insertions (4.6% versus 2.2%, P<0.05). Lower incidence of postoperative ventricular arrhythmias, shorter intubation time and less transient renal failures were significant in group 2 compared with those in group 1 ( P<0.001), while re-exploration of bleeding, wound infections, pulmonary, neurological and gastrointestinal complications did not differ. Blood transfusion was less in group 2 (1.2(1.1) units, P<0.001). On day 1 after surgery, serum creatinine, lactate dehydrogenase and creatine phosphokinase values were increased in both groups but were significantly lower in group 2 ( P<0.001). Normothermic cardiopulmonary bypass combined with cold cardioplegic arrest is safe and provides sufficient cardiac and total body protection during primary CABG. Several of the adverse effects of hypothermia can be avoided, such as prolonged cardiopulmonary bypass time and ventilatory support, disturbed haemostasis and transient renal failure.

Effect of Magnesium on Postoperative Dysrhythmias

To the Editor. —The study methods by England et al 1 leave some doubts as to their conclusion that magnesium administration after cardiac surgery decreases the incidence of postoperative ventricular arrhythmias and increases postoperative stroke volume. The patient population included a wide variety of cardiac procedures and the authors do not state whether the groups were matched with respect to the type of valve procedure or procedures, including ventricular aneurysmectomy and the implantable defibrillator. They also do not state whether electrocardiographic monitoring continued after patients were transferred from the intensive care unit, when many arrhythmias occur. For purposes of analysis, they lump all ventricular arrhythmias in a single group, but include patients experiencing unifocal premature depolarization at a frequency greater than one per minute, which may not have the same prognostic importance as other ventricular arrhythmias (especially in patients with ischemic heart disease). These flaws seriously undermine their conclusion that

Total exchangeable potassium, sodium and chloride in patients with severe valvular heart disease during preparation for cardiac surgery.

Exchangeable potassium, sodium and chloride were measured in 41 patients with severe valvular heart disease subjected to optimal medical treatment during preparation for intracardiac surgery. The results obtained were evaluated with the aid of two references for normal body composition: (1) ideal body weight, based upon body height, and (2) population weight taking into account body height and body weight increasing with age. According to both references, total exchangeable potassium was below normal, while exchangeable sodium and chloride were slightly elevated or normal. The decrement of exchangeable potassium, which was most pronounced in patients receiving diuretics, was interpreted as being due to a decrease of body cell mass in response to chronic wasting illness. No correlation was found between the incidence of postoperative ventricular arrhythmias and the decrease of exchangeable potassium or previous use of diuretics.

Effect of modified preoperative, intraoperative, and postoperative potassium supplementation on the incidence of postoperative ventricular arrhythmias

Effect of modified preoperative, intraoperative, and postoperative potassium supplementation on the incidence of postoperative ventricular arrhythmias