Postoperative Supraventricular Tachycardia Research Articles

Sutureless technique combined with vertical vein incision and pulmonary veins unroofed for correction of infracardiac total anomalous pulmonary venous connection.

We report a surgical method (sutureless technique), combined with vertical vein incision and pulmonary veins unroofed (semisutureless technique), to correct infracardiac total anomalous pulmonary venous connection (TAPVC). The clinical characteristics of 21 patients, who were diagnosed with infracardiac TAPVS between February 2017 and March 2022, were retrospectively analyzed. These patients were divided into three groups according to different surgical methods: conventional surgery group, sutureless technique group, and semisutureless technique group. The conventional surgery group enrolled five patients with a median age of 16 days (interquartile range, 9-27 days) and a median weight of 3.25 kg (interquartile range, 3.1-3.42 kg). In this group, no preoperative pulmonary vein obstruction (PVO), preoperative ventilator support, or emergency surgery were reported. The sutureless technique group enrolled seven patients with a median age of 12 days (interquartile range, 5-16 days) and a median weight of 3.04 kg (interquartile range, 2.76-3.20 kg). In this group, two patients with preoperative PVO, four patients with preoperative ventilator support, and seven patients requiring emergency operation were found. The semisutureless technique group enrolled nine patients with a median age of 14 days (interquartile range, 7-24 days) and a median weight of 3.22 kg (interquartile range, 3.15-3.50 kg). In this group, four patients with preoperative PVO, two patients with preoperative ventilator support, and seven patients requiring emergency operation were noted. In the conventional surgery group, two patients with postoperative supraventricular tachycardia, one patient with postoperative low cardiac output syndrome, one patient with PVO, and no case of postoperative death were reported. In the sutureless technique group, two patients with postoperative low cardiac output syndrome, one patient with postoperative supraventricular tachycardia, one patient with postoperative PVO, and no postoperative deaths were determined. In the semisutureless technique group, three patients had low cardiac output syndrome, two patients had supraventricular tachycardia after the operation, and one patient, who had been admitted to the hospital after cardiopulmonary resuscitation in the emergency room, died early after the operation. No case of death or PVO was noted after the operation. The semisutureless technique has positive effects. This surgery method can enlarge the anastomotic stoma, increase the volume of the left atrium, reduce the tension of the anastomotic stoma, fix the pulmonary vein to avoid distortion, and prevent postoperative hemorrhage.

Value of provocative electrophysiology testing in the management of pediatric patients after congenital heart surgery.

To determine the impact of provocative electrophysiology testing in postoperative congenital heart disease (CHD) patients on the management of supraventricular tachycardia (SVT) and clinical outcomes. This is a retrospective study including patients<18 years of age with surgery for CHD who had postoperative SVT between 2006 and 2017. Postoperative outcomes were compared between patients with and without postoperative electrophysiology testing using the Wilcoxon rank sum test, Fisher's exact test, Kaplan-Meier method with the log-rank test, and Cox proportional hazard model. From 341 patients who had SVT after surgery for CHD, 65 (19%) had postoperative electrophysiology testing. There was no significant difference in baseline patient characteristics or surgical complexity between patients with and without electrophysiology testing. Patients with inducible SVT on electrophysiology testing were more likely to have recurrence of SVT prior to hospital discharge with an odds ratio 4.0 (95% confidence interval 1.3, 12.0). Patients who underwent postoperative electrophysiology testing had shorter intensive care unit (12 [6, 20] vs 16 [9, 32] days, HR 2.1 [95% CI 1.6, 2.8], P<.001) and hospital (25 [13, 38] vs 31 [18, 54] days, HR 1.8 [95% CI 1.4, 2.4], P<.001) length of stay. Postoperative electrophysiology testing was associated with improved postoperative outcomes, likely related to the ability to predict recurrence of arrhythmia and tailored antiarrhythmic management.

Postoperative supraventricular tachycardia and polymorphic ventricular tachycardia due to a novel SCN5A variant: a case report of a rare comorbidity that is difficult to diagnose

BackgroundLoss-of-function mutations of human cardiac sodium channel gene SCN5A induce a wide range of arrhythmic disorders. Mutation carriers with co-existing conditions such as congenital heart diseases and histories of cardiac surgeries, could develop complex arrhythmic events that are difficult to diagnose.Case presentationA 41-year-old Japanese male with a history of a surgical closure of an ASD presented impairment of consciousness by wide QRS tachycardia. Because the patient’s baseline ECG in sinus rhythm showed similar QRS axis with right bundle brunch block morphology, we suspected supraventricular tachycardia (SVT). During hospitalization, the patient developed polymorphic ventricular tachycardia that was induced by bradycardia. In an electrophysiological study, the SVT was identified as right atrial incisional tachycardia circulating around the scar in the right atrium.The genetic analysis revealed a heterozygous SCN5A c.4037–4038 del TC, p. L1346HfsX38 variant. We diagnosed this patient as having progressive cardiac conduction disorder (PCCD) and polymorphic VT caused by the mutation. Incisional tachycardia with wide QRS morphology was a by-standing comorbidity related to the history of cardiac surgery which could miss lead the diagnosis.The patient’s SVT was eliminated by radiofrequency catheter ablation. An implantable cardioverter defibrillator (ICD) was implanted for the secondary prevention of polymorphic VT. Cardiac pace-making therapy by the ICD to avoid bradycardia effectively suppressed the patient’s arrhythmic events.ConclusionsWe treated a patient with a sodium channel gene variant. Co-existing SVT originated by a scar in the right atrium made the diagnosis extremely difficult. A multilateral diagnostic approach using an ECG analysis, an electrophysiological study, and genetic screening enabled effective combination therapy comprised of catheter ablation and an ICD.

Efficacy analysis on arterial catheter stents for pulmonary atresia with intact ventricular septum in newborns

Objective To compare the efficacy of arterial stenting with that of traditional B-T shunt for neonatal pulmonary atresia with intact ventricular septum. Methods Twenty-six cases of neonatal pulmonary atresia with intact ventricular septum were treated at Children′s Hospital of Zhengzhou from December 2005 to December 2015, aged 3 to 23 days[(8.20±4.80) days], and weighted 2.80-3.88 (3.41±0.27) kg.Accompanied with pulmonary hypoplasia, all these patients were combined with PDA and ASD or PFO.Before operation, the peripheral oxygen saturation was kept in 61%-75%, averaged at 67%.Among them, 12 cases underwent arterial catheter stenting, and 14 cases received B-T shunt (including modified B-T shunt and central shunt) ductus ligation.After operation, the oxygen saturation in these children was observed, and they were examined by echocardiography and true lateral chest X-ray, blood flow situations in stents and shunts were assessed, and follow-up examinations were conducted in 1, 3, 6 and 12 months postoperatively. Results Stents were successfully inserted into these 12 cases.After traditional pulmonary shunt, patients′ peripheral oxygen saturation was (82.73±5.59)%, compared with that of patients after arterial catheter sten-ting (86.18±3.19)%, there was significant difference(t=10.71, P<0.05). In pulmonary shunt group, 2 cases died, 1 case died of postoperative heart failure, and the other case was complicated with pulmonary infection and died of respiratory failure; in catheter stent group, 1 case was complicated with postoperative supraventricular tachycardia and recovered after drug intervention.For the follow-up examinations 1, 3, 6 and 12 months after the operation, 1 case of B-T shunt in pulmonary shunt group was improved by central shunt due to slow blood flow, less shunt volume, and oxygen saturation decreased to 69%.For the catheter stent group, 1 case was improved by stent balloon dilatation due to declined peripheral oxygen saturation 2 months postoperatively, and after the operation, transcutaneous oxygen saturation was improved.No patients died in the catheter stent group. Conclusions In traditional B-T shunts, the operation is extensive, and complications are common, and the recovery turns slowly.Arterial catheter stenting can be used as the preferred method of treatment for one-stage surgical pulmonary atresia with intact ventricular septum to reduce the weakness feasibly and effectively. Key words: Pulmonary atresia; Pulmonary shunt; Infant, newborn; Artery catheter; Stent

Incidence and implications of postoperative supraventricular tachycardia after pulmonary lobectomy

ObjectiveWe sought to determine the rate of postoperative supraventricular tachycardia (POSVT) in patients undergoing pulmonary lobectomy, and its association with adverse outcomes. MethodsUsing the State Inpatient Database, from the Healthcare Cost and Utilization Project, we reviewed lobectomies performed (2009-2011) in California, Florida, and New York, to determine POSVT incidence. Patients were grouped by presence or absence of POSVT, with or without other complications. Stroke rates were analyzed independently from other complications. Multivariable regression analysis was used to determine factors associated with POSVT. ResultsAmong 20,695 lobectomies performed, 2449 (11.8%) patients had POSVT, including 1116 (5.4%) with isolated POSVT and 1333 (6.4%) with POSVT with other complications. Clinical predictors of POSVT included age ≥75 years, male gender, white race, chronic obstructive pulmonary disease, congestive heart failure, thoracotomy surgical approach, and pulmonary complications. POSVT was associated with an increase of: stroke (odds ratio [OR] 1.74; 95% confidence interval [CI] 1.03-2.94); in-hospital death (OR 1.85; 95% CI 1.45-2.35); LOS (OR 1.33; 95% CI 1.29-1.37); and readmission (OR 1.29; 95% CI 1.04-1.60). The stroke rate was <1% in patients who had isolated POSVT, and 1.5% in patients with POSVT with other complications. Patients with isolated POSVT had increased readmission and LOS, and a marginal increase in stroke rate, compared with patients with an uncomplicated course. ConclusionsPOSVT is common in patients undergoing pulmonary lobectomy and is associated with adverse outcomes. Comparative studies are needed to determine whether strict adherence to recently published guidelines will decrease the rate of stroke, readmission, and death after POSVT in thoracic surgical patients.

OP-131 Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients?

OP-131 Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients?

Untreated preoperative depression is not associated with postoperative arrhythmias in CABG patients

The mechanism by which depression affects postoperative outcome may involve arrhythmias. The purpose of this study was to evaluate whether untreated depression is associated with an increased incidence of postoperative arrhythmias in patients undergoing coronary artery bypass graft surgery (CABG). One hundred seven patients were assessed for signs of depression with the Prime-MD Patient Health Questionnaire (brief PHQ) one week before surgery and subsequently underwent Holter monitoring for 48-72 hr postoperatively. The incidences of atrial fibrillation (AF); supraventricular tachycardia (SVT); ventricular tachycardia (VT), defined as three or more consecutive beats at a cycle length less than 600 msec; ventricular fibrillation (VF); and average heart rate (HR) were recorded in patients with and without signs of depression. The incidence of preoperative untreated depression was 27% (29/107). Twenty patients had mild depression (brief PHQ score of 5-9), seven patients had moderate depression (a score of 10-14), and two patients had severe depression (a score of 20). The incidences of postoperative AF, SVT, and non-sustained VT in depressed and non-depressed patients were 37.9% vs 35.9%, respectively (P = 0.50), 34.4% vs 52.5%, respectively (P = 0.07), and 17.2% vs 37.1%, respectively (P = 0.04). The average (SD) postoperative HR was similar in both groups [95 (12) beats·min(-1) in depressed patients and 92 (10) beats·min(-1) in non-depressed patients, (P = 0.25)]. Multivariate regression analysis showed that older age, but not depression, was a risk factor for postoperative arrhythmia. Preoperative untreated depression is not related to postoperative arrhythmia in the early postoperative period in patients undergoing elective CABG. This trial was registered at clinicaltrials.gov (number: NCT00622024).

Clinical impact of preoperative electrophysiological intervention on postoperative supraventricular tachycardia events following Fontan procedure

Clinical impact of preoperative electrophysiological intervention on postoperative supraventricular tachycardia events following Fontan procedure

Effect of landiolol hydrochloride, an ultra-short-acting beta 1-selective blocker, on supraventricular tachycardia, atrial fibrillation and flutter after pulmonary resection

Supraventricular tachycardia is a common complication after pulmonary resection. The objective of this study was to investigate the efficacy of landiolol hydrochloride, an ultra-short-acting β1-blocker, in patients with post-operative supraventricular tachycardia after pulmonary resection. The response to continuous intravenous infusion of landiolol was evaluated in 25 patients who developed post-operative atrial fibrillation or atrial flutter after major pulmonary resection. Four patients had preoperative rate-controlled chronic atrial fibrillation. The heart rate and blood pressure were compared before and after infusion of landiolol. Side effects and recurrence of supraventricular tachycardia after termination of landiolol infusion were also monitored. The heart rate was reduced from 135±24 bpm before landiolol infusion to a plateau rate of 85±19 bpm during infusion (P<0·0001). Heart rate reduction occurred in all but two patients. Conversion to normal sinus rhythm from supraventricular tachycardia occurred in 14 patients (56%). Recurrence of supraventricular tachycardia after stopping landiolol infusion was observed in 17 patients (68%), but all patients without preoperative AF were cured of post-operative AF. There were no detectable side effects, including no adverse influence on the circulatory and respiratory systems. Continuous intravenous infusion of landiolol was found to be effective and safe for supraventricular tachycardia after pulmonary resection.

Right Ventricular Echocardiographic Predictors of Postoperative Supraventricular Arrhythmias After Thoracic Surgery: A Pilot Study

We used echocardiographically derived myocardial performance index (MPI) to assess changes in global right ventricular function with lung isolation. We hypothesized that changes in MPI with lung isolation may be related to the incidence of postoperative supraventricular tachycardia (SVT). Transesophageal echocardiographic examinations were performed after induction of general anesthesia in patients undergoing elective lung resections. Doppler tissue imaging was used to calculate MPI at baseline and 10 minutes after institution of one-lung ventilation (OLV). Arrhythmias occurring within the first 5 postoperative days were recorded. Fifty-nine patients completed the study. Nineteen of 59 patients with a normal baseline MPI (<0.40) had a higher incidence of SVT as compared with patients with an abnormal baseline MPI (42% versus 10%; p = 0.012). The MPI worsened during OLV in 46 patients; a worsening of MPI with lung isolation that was normal at baseline was associated with higher incidence of SVT (57% versus 0%; p = 0.045) compared with a worsening of MPI in patients with an abnormal baseline MPI (13% versus 6%; p = 0.62). A normal baseline MPI value that worsened after OLV, left atrial dilation, and advanced age were identified as predictors of postoperative SVT. Lung isolation is associated with acute changes in global right ventricular function. A normal baseline MPI that worsens after lung isolation is a better predictor of postoperative SVT as compared with baseline abnormal MPI that does not worsen after lung isolation. Myocardial performance index has a potential to be used as a right ventricular stress test to tolerate OLV before thoracic surgery.

Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence After Coronary Artery Bypass Operations in Diabetic Patients?

Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence After Coronary Artery Bypass Operations in Diabetic Patients?

Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence After Coronary Artery Bypass Operations in Diabetic Patients?

To compare continuous insulin infusion (CII) and intermittent subcutaneous insulin therapy for preventing supraventricular tachycardia. The authors propose that continuous insulin therapy is more effective to reduce supraventricular tachycardias. A prospective randomized study. This study was performed in 2 different centers between April 2005 and February 2007: Gülhane Military Medical Academy and University of Süleyman Demirel. Two hundred diabetic patients were included in this prospective randomized study. Patients were divided into 2 groups according to their insulin therapy in 2 different centers. Group 1 included 100 diabetes mellitus (DM) patients, and CIIs were administrated. These patients received a CII infusion titrated per protocol in the perioperative period (Portland protocol). Group 2 also included 100 DM patients, and subcutaneous insulin was injected every 4 hours in a directed attempt to maintain blood glucose levels below 200 mg/dL. Sliding scale dosage of insulin was titrated to each patient's glycemic response during the prior 4 hours. There were 5 hospital mortalities in the intermittent insulin group. The causes of death were pump failure in 3 patients and ventricular fibrillation in 2 patients. There were 2 hospital mortalities in the CII group (p = 0.044). Thirty-six patients in the intermittent insulin group and 21 patients in the CII group required positive inotropic drugs after cardiopulmonary bypass (p = 0.028). Low cardiac output developed in 28 and 16 patients in the intermittent and CII groups, respectively (p = 0.045). Univariate analysis identified positive inotropic drug requirement (p = 0.011, odds ratio [OR] = 3.41), ejection fraction (EF) (p = 0.001, OR = 0.92), cross-clamp time (p = 0.046, OR = 0.97), left internal mammary artery (p = 0.023, OR = 0.49), chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second <75% of predicted value (p = 0.009, OR = 2.02), intra-aortic balloon pump (p = 0.045, OR = 1.23), body mass index (p = 0.035 OR = 5.60), and CII (p < 0.001, OR = 0.36) as predictors of SVT. Stepwise multivariate analysis confirmed the significance of some of the previously mentioned variables as predictors of SVT. The value of -2 log likelihood of multivariate analyses was 421.504. These were EF (p < 0.001, OR = 0.91), positive inotropic drug requirement (p < 0.001, OR = 3.94), COPD (p = 0.036, OR = 2.11), and CII (p < 0.001, OR = 0.19). Continuous insulin therapy in the perioperative period reduces infectious complications, such as sternal wound infection and mediastinitis, cardiac mortality caused by pump failure, and the risk of development of supraventricular tachycardias.

Training general surgery residents to avoid postoperative cardiac events

Background Expertise in cardiac risk assessment takes years to acquire, but unnecessary cardiology consultation delays treatment and consumes scarce resources. Methods A retrospective review was performed of the cardiac work-up and postoperative events during 1 year on a general surgery service. Postgraduate year 1–3 general surgery residents were instructed to obtain a cardiology consult if a patient had any of the following: (1) had undergone coronary artery intervention more than 2 years in the past; (2) was taking an anti-anginal medication (nitroglycerine, Ca channel, or β-blocker); or (3) was symptomatic or had an abnormal electrocardiogram. Whether a patient was symptomatic was to be tempered by the nature of the planned procedure. Results Supervised residents screened 720 unique patients for surgery. Cardiology consultation was obtained in 37. All but 1 (97%) patient referred to cardiology met at least 1 of the earlier-described criteria; with 8 (22%) meeting all 3 criteria. On average, patients referred to the cardiologists were taking 1.4 anti-anginal medications; and 1 patient sustained a fatal myocardial infarction after referral. Cardiac imaging (stress test or catheterization) was performed on 24 (65%) referred patients and was positive in 8 (33%). After minimizing cardiac risk by medication or intervention, the surgery service declined to offer the planned procedure to 11 (30%) of the referred patients and an additional 5 (15%) patients declined surgery. The overall surgical mortality was 2%. None of the patients in this series sustained a postoperative myocardial infarction or cardiac death. Postoperative supraventricular tachycardia was not influenced significantly by cardiology consultation (5% referred patients vs 1% nonreferred). Conclusions Our criteria for obtaining cardiology consultation in general surgery patients appears to appropriately select patients in need of further work-up. Information obtained from a cardiac consultation frequently leads to a re-evaluation of the risks and benefits of surgery by both surgeons and patients.

Outcomes of Off-Pump versus On-Pump Coronary Artery Bypass Surgery in End-Stage Renal Disease Patients with a History of Myocardial Infarction

Patients with end-stage renal disease (ESRD) and myocardial infarction (MI) have poor survival. Coronary artery bypass grafting (CABG) in select patients is an effective treatment strategy; however, whether operative technique influences hospital outcome is not defined. Between 1995 and 2000, 342 patients had ESRD (creatinine >2.0 mg/dL or dialysis) and a history of MI at the time of CABG. There were 67 patients that had off-pump coronary artery bypass (OPCAB) (OFF) and 275 that had CABG (ON). The OFF group was compared to the ON group for clinical, operative, outcome data, and influence of acuity of MI. The OFF group was older (P = .09), but hypertension was more common in the ON group (82% versus 69%, P = .02). The frequency of diabetes, congestive heart failure, peripheral vascular disease, and dyslipidemia were common, but not different between groups. For the OFF versus ON group, creatinine serum level was 3.6 +/- 2.6 versus 3.5 +/- 3.1 (P = 0.17), and history of an acute MI was 39% versus 33% (P = 0.78). The OFF versus ON group had fewer total grafts (2.5 +/- 1 versus 3.8 +/- 1, P < .001). The OFF group had fewer strokes (P = .08), shorter intensive care unit stay (2.4 versus 3.8 days), and shorter hospitalization (8.4 versus 11.7 days), yet mortality was similar (7% versus 9%, P = .79). After acute MI, OFF patients had significantly more postoperative supraventricular tachycardia than ON (69% versus 19%, P < .001). Patients with ESRD and an MI have acceptable hospital outcomes regardless of operative strategy. OPCAB or CABG may provide an advantage in certain patients, yet it is the presence of an acute MI that is a predictor of postoperative events.

Role of adenosine in the diagnosis and treatment of postoperative supraventricular tachyarrhythmias

Adenosine (Adenocard) has a potent but very transient negative dromotropic effect on atrioventricular (A-V) nodal conduction. By slowing A-V nodal conduction, adenosine may interrupt a re-entry pathway causing paroxysmal supraventricular tachycardia or facilitate the diagnosis of other supraventricular tachycardia (SVT) by exposing the underlying atrial activity. We report 15 postoperative cases in which adenosine was used to clarify the diagnosis of postoperative SVT, and allowed the appropriate postoperative care.

Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after coronary artery bypass

The influence of 45 variables on risk of postoperative supraventricular tachycardia was evaluated by univariate and multivariate analysis of data from 800 consecutive patients who underwent isolated coronary artery bypass during a 6-year interval. Postoperative supraventricular arrhythmias occurred in 186 patients (23%) but did not contribute to any of the six early deaths (30-day mortality rate, 0.8%). Mean (+/- standard deviation) length of hospital stay was longer (9.8 +/- 5.7 versus 8.3 +/- 3.5 days; p less than 0.0001) and mean age was older (65 versus 60 years; p less than 0.002) in patients with postoperative supraventricular tachycardia than in those with regular rhythm. Risk of supraventricular tachycardia was increased in patients with a history of atrial arrhythmias (45% versus 22%; p less than 0.002) or premature atrial contractions on the preoperative electrocardiogram (48% versus 22%; p less than 0.002). Multiple logistic regression analysis identified age 65 years or more, history of atrial arrhythmia or preoperative premature atrial contractions, and preoperative left ventricular end-diastolic pressure 20 mm Hg or more as independent predictors of postoperative supraventricular tachycardia. Six percent of patients converted to sinus rhythm spontaneously; 82% of patients converted within 1.1 +/- 1.9 days after onset of supraventricular tachycardia on treatment with digoxin or beta-adrenergic blocking drugs or both. Only 10% of patients with supraventricular tachycardia required electrical cardioversion. We conclude that the risk of supraventricular tachycardia after coronary artery bypass is influenced by patient-related variables and is effectively managed by conventional therapy. Prophylactic treatment should be reserved for elderly patients, especially those who have atrial arrhythmias or have preoperative left ventricular end-diastolic pressure 20 mm Hg or more.

Oral verapamil fails to prevent supraventricular tachycardia following coronary artery surgery

A prospective randomised trial was performed on 100 patients undergoing coronry artery bypass grafting without concomitant procedure. The study group commenced oral verapamil 40 mg three times daily on the first post-operative day while the control group received no antiarrhythmic agents. The pre-operative characteristics of both groups were similar with the exception of the incidence of hyperlipidemia which was greater in the verapamil group ( P = 0.04). Myocardial protection was achieved with cold crystalloid cardioplegia. Cardiopulmonary bypass times, aortic cross clamp times and graft numbers were similar for both groups. Nine patients were excluded on the first post-operative day; the remainder were studied for 8 days. Supraventricular tachyarrhythmias (atrial fibrillation, atrial flutter or paroxysmal supraventricular tachycardia) were detected in 8 patients in the study group ( n = 44) and in 5 patients in the control group ( n = 47). The difference was not significant ( P = 0.3). The ventricular rate in patients taking verapamil who developed supraventricular tachycardia was 138 ± 14.9 compared with 156.8 ± 17.9 in the control group, but the difference failed to reach significant levels ( P = 0.065). In conclusion, prophylactic oral verapamil 40 mg given three times daily after coronary artery surgery failed to decrease the incidence of post-operative supraventricular tachycardia or to significantly influence the ventricular rate if tachycardia developed.

Supraventricular tachycardia complicating surgical procedures; a study of the contributing causes, course, and treatment of this complication in fifty patients.

Persistent postoperative supraventricular tachycardia, despite adequate therapy, is a bad prognostic sign, and cardiac failure due to, or associated with, arrhythmia responds poorly to treatment. Of the 12 patients (24 per cent) resistent to therapy, eight developed congestive heart failure, with five dying as a result. The preoperative, intraoperative and postoperative factors contributing to the causes of this complication are reviewed, and the therapy, course and end results are discussed.