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Postoperative Rhythm Disorders After Adult Cardiac Surgeries

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Postoperative Critical Care for Cardiac Surgical Patients
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Abstract

New-onset arrhythmias are a common complication of cardiac surgery. Atrial fibrillation is the most common arrhythmia encountered postoperatively, although ventricular arrhythmias and conduction disturbances can also occur. Postoperative arrhythmias are an important cause of increased morbidity, prolonged hospitalization, and higher medical costs. Prophylactic pharmacological and non-pharmacological treatments are highly useful in avoiding these problems.

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Abbreviations

ACCF:

American College of Cardiology Foundation

AF:

Atrial fibrillation

AFL:

Atrial flutter

AHA:

American Heart Association

AT:

Atrial tachycardia

AV:

Atrioventricular

AVB:

Atrioventricular block

BiA:

Biatrial pacing

CABG:

Coronary artery bypass grafting

ESC:

European Society of Cardiology

PVC:

Premature ventricular complex

SND:

Sinus node dysfunction

VA:

Ventricular arrhythmia

VT:

Ventricular tachycardia

References

  • Alghamdi AA, Al-Radi OO, Latter DA (2005) Intravenous magnesium for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and meta-analysis. J Card Surg 20:293–299

    Article  PubMed  Google Scholar 

  • Almassi GH, Schowalter T, Nicolosi AC et al (1997) Atrial fibrillation after cardiac surgery. A major morbid event? Ann Surg 226:501–513

    Article  PubMed  CAS  Google Scholar 

  • Amar D, Shi W, Hogue CW Jr, Zhang H et al (2004) Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol 44:1248–1253

    Article  PubMed  Google Scholar 

  • Archbold RA, Schilling RJ (2004) Atrial pacing for the prevention of atrial fibrillation after coronary artery bypass graft surgery: a review of the literature. Heart 90:129–133

    Article  PubMed  CAS  Google Scholar 

  • Ascione R, Caputo M, Calori G et al (2000) Predictors of atrial fibrillation after conventional and beating heart coronary surgery: a prospective, randomized study. Circulation 102:1530–1535

    Article  PubMed  CAS  Google Scholar 

  • Asher CR, Miller DP, Grimm RA et al (1998) Analysis of risk factors for development of atrial fibrillation early after cardiac valvular surgery. Am J Cardiol 82:892–895

    Article  PubMed  CAS  Google Scholar 

  • Bagshaw SM, Galbraith PD, Mitchell LB et al (2006) Prophylactic amiodarone for prevention of atrial fibrillation after cardiac surgery: a meta-analysis. Ann Thorac Surg 82:1927–1937

    Article  PubMed  Google Scholar 

  • Brembilla-Perrot B, Villemot JP, Carteaux JP et al (2003) Postoperative ventricular arrhythmias after cardiac surgery: immediate- and long-term significance. Pacing Clin Electrophysiol 26:619–625

    Article  PubMed  Google Scholar 

  • Brodell GK, Cosgrove D, Schiavone W et al (1991) Cardiac rhythm and conduction disturbances in patients undergoing mitral valve surgery. Cleve Clin J Med 58:397–399

    Article  PubMed  CAS  Google Scholar 

  • Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429

    Article  PubMed  Google Scholar 

  • Chung MK (2000) Cardiac surgery: postoperative arrhythmias. Crit Care Med 28(Suppl):N136–N144

    Article  PubMed  CAS  Google Scholar 

  • Chung MK, Martin DO, Sprecher D et al (2001) C-reactive protein in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 104:2886–2891

    Article  PubMed  CAS  Google Scholar 

  • Creswell LL, Schuessler RB, Rosenbloom M et al (1993) Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 56:539–549

    Article  PubMed  CAS  Google Scholar 

  • Crystal E, Connolly SJ, Sleik K et al (2002) Intervention on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation 106:75–80

    Article  PubMed  Google Scholar 

  • De Vecchi E, Pala MG, Di Credico G et al (1998) Relation between left ventricular function and oxidative stress in patients undergoing bypass surgery. Heart 79:242–247

    PubMed  Google Scholar 

  • El-Chami MF, Sawaya FJ, Kilgo P et al (2012) Ventricular arrhythmia after cardiac surgery: incidence, predictors, and outcomes. J Am Coll Cardiol 60:2664–2671

    Article  PubMed  Google Scholar 

  • Fan K, Lee K, Lau CP (2003) Mechanisms of biatrial pacing for prevention of postoperative atrial fibrillation – insights from a clinical trial. Card Electrophysiol Rev 7:147–153

    Article  PubMed  Google Scholar 

  • Fanning WJ, Thomas CS Jr, Roach A et al (1991) Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting. Ann Thorac Surg 52:529–533

    Article  PubMed  CAS  Google Scholar 

  • Fogel RI, Prystowsky EN (2000) Management of malignant ventricular arrhythmias and cardiac arrest. Crit Care Med 28(Suppl):N165–N169

    Article  PubMed  CAS  Google Scholar 

  • Fuster V, Ryden LE, Cannom DS et al (2011) 2011 CCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 123:e269–e367

    Article  PubMed  Google Scholar 

  • Goldman BS, Hill TJ, Weisel RD et al (1984) Permanent cardiac pacing after open-heart surgery: acquired heart disease. Pacing Clin Electrophysiol 7:367–371

    Article  PubMed  CAS  Google Scholar 

  • Grant SC, Khan MA, Faragher EB et al (1995) Atrial arrhythmias and pacing after orthotopic heart transplantation: bicaval versus standard atrial anastomosis. Br Heart J 74:149–153

    Article  PubMed  CAS  Google Scholar 

  • Haghjoo M, Saravi M, Hashemi MJ et al (2007) Optimal beta-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: carvedilol versus metoprolol. Heart Rhythm 4:1170–1174

    Article  PubMed  Google Scholar 

  • Hakala T, Pitkanen O, Hippelainen M (2002) Feasibility of predicting the risk of atrial fibrillation after coronary artery bypass surgery with logistic regression model. Scand J Surg 91:339–344

    PubMed  CAS  Google Scholar 

  • Ho KM, Tan JA (2009) Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose–response meta-analysis. Circulation 119:1853–1866

    Article  PubMed  CAS  Google Scholar 

  • Huikuri HV, Yli-Mayry S, Korhonen UR et al (1990) Prevalence and prognostic significance of complex ventricular arrhythmias after coronary arterial bypass graft surgery. Int J Cardiol 27:333–339

    Article  PubMed  CAS  Google Scholar 

  • Ishii Y, Schuessler RB, Gaynor SL et al (2005) Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation. Circulation 111:2881–2888

    Article  PubMed  CAS  Google Scholar 

  • Jaeger FJ, Trohman RG, Brener S et al (1994) Permanent pacing following repeat cardiac valve surgery. Am J Cardiol 74:505–507

    Article  PubMed  CAS  Google Scholar 

  • Kaplan M, Kut MS, Icer UA et al (2003) Intravenous magnesium sulfate prophylaxis for atrial fibrillation after coronary artery bypass surgery. J Thorac Cardiovasc Surg 125:344–352

    Article  PubMed  CAS  Google Scholar 

  • Korantzopoulos P, Kolettis TM, Galaris D et al (2006) The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. Int J Cardiol 115:135–143

    Article  PubMed  Google Scholar 

  • Lahtinen J, Biancari F, Salmela E et al (2004) Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery. Ann Thorac Surg 77:1241–1244

    Article  PubMed  Google Scholar 

  • Leitch JW, Thomson D, Baird DK et al (1990) The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 100:338–342

    PubMed  CAS  Google Scholar 

  • Merin O, Ilan M, Oren A et al (2009) Pacing. Clin Electrophysiol 32:7–12

    Article  Google Scholar 

  • Passman R, Beshai J, Pavri B et al (2001) Predicting post-coronary bypass surgery atrial arrhythmias from the preoperative electrocardiogram. Am Heart J 142:806–810

    Article  PubMed  CAS  Google Scholar 

  • Pfisterer ME, Klöter-Weber UC, Huber M et al (1997) Prevention of supraventricular tachyarrhythmias after open heart operation by low-dose sotalol: a prospective, double-blind, randomized, placebo-controlled study. Ann Thorac Surg 64:1113–1119

    Article  PubMed  CAS  Google Scholar 

  • Pinto RP, Romerill DB, Nasser WK et al (1996) Prognosis of patients with frequent premature ventricular complexes and nonsustained ventricular tachycardia after coronary artery bypass graft surgery. Clin Cardiol 19:321–324

    Article  PubMed  CAS  Google Scholar 

  • Smith RC, Leung JM, Keith FM et al (1992) Ventricular dysrhythmias in patients undergoing coronary artery bypass graft surgery: incidence, characteristics, and prognostic importance. Am Heart J 123:73–81

    Article  PubMed  CAS  Google Scholar 

  • Tam SK, Miller JM, Edmunds LH Jr (1991) Unexpected, sustained ventricular tachyarrhythmia after cardiac operations. J Thorac Cardiovasc Surg 102:883–889

    PubMed  CAS  Google Scholar 

  • Tracy CM, Epstein AE, Darbar D et al (2013) 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 61:e6–e75

    Article  PubMed  Google Scholar 

  • VanderLugt JT, Mattioni T, Denker S et al (1999) Efficacy and safety of ibutilide fumarate for the conversion of atrial arrhythmias after cardiac surgery. Circulation 100:369–375

    Article  PubMed  CAS  Google Scholar 

  • Wahr JA, Parks R, Boisvert D et al (1999) Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. Multicenter Study of Perioperative Ischemia Research Group. JAMA 281:2203–2210

    Article  PubMed  CAS  Google Scholar 

  • Weber UK, Osswald S, Buser P et al (1998) Significance of supraventricular tachyarrhythmias after coronary artery bypass graft surgery and their prevention by low-dose sotalol: a prospective double-blind randomized placebo controlled study. J Cardiovasc Pharmacol Ther 3:209–216

    Article  PubMed  CAS  Google Scholar 

  • Yavuz T, Bertolet B, Bebooul Y et al (2004) Role of endogenous adenosine in atrial fibrillation after coronary artery bypass graft. Clin Cardiol 27:343–346

    Article  PubMed  Google Scholar 

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Correspondence to Majid Haghjoo MD .

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Haghjoo, M. (2014). Postoperative Rhythm Disorders After Adult Cardiac Surgeries. In: Dabbagh, A., Esmailian, F., Aranki, S. (eds) Postoperative Critical Care for Cardiac Surgical Patients. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40418-4_9

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  • DOI: https://doi.org/10.1007/978-3-642-40418-4_9

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