Malignant ventricular arrhythmias after off-pump coronary artery bypass

Jeng-Wei Chen; Cheng-Hsin Lin; Ron-Bin Hsu

doi:10.1016/j.jfma.2014.02.005

Malignant ventricular arrhythmias after off-pump coronary artery bypass

J Formos Med Assoc. 2015 Oct;114(10):936-42. doi: 10.1016/j.jfma.2014.02.005. Epub 2014 Mar 15.

Authors

Jeng-Wei Chen¹, Cheng-Hsin Lin¹, Ron-Bin Hsu²

Affiliations

¹ Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
² Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC. Electronic address: ronbin@ntuh.gov.tw.

PMID: 24642387
DOI: 10.1016/j.jfma.2014.02.005

Abstract

Background/purpose: Sustained ventricular tachycardia and ventricular fibrillation (VT/VF) are rare complications after coronary surgery. Off-pump coronary artery bypass (OPCAB) was developed to decrease postoperative complications. No studies to date have specifically addressed VT/VF after OPCAB. We sought to assess the incidence, risk factors, and outcome of VT/VF after OPCAB.

Methods: The study included a retrospective review of 1010 patients undergoing OPCAB between 2000 and 2012. Data were compared between the VT/VF patients and control patients who were the first cases of OPCAB in each month during the study period and did not have VT/VF.

Results: Twenty-three patients (2.3%) developed VT/VF after OPCAB. The hospital mortality rate was 17.4%. In univariate analysis, the risk factors for VT/VF were old age, rapid heart rate, prolonged corrected QT interval, severe congestive heart failure, poor left ventricular ejection fraction, large left ventricular end-diastolic diameter, chronic kidney disease, preoperative dialysis, low blood hemoglobin level, preoperative intubation, recent myocardial infarction, high European System for Cardiac Operative Risk Evaluation, urgent/emergent operation, use of intra-aortic balloon pump, conversion to on-pump beating heart, postoperative dialysis, and no use of beta-blockers after operation. Multivariate analysis identified preoperative corrected QT interval > 426 milliseconds [odds ratio (OR) = 4.501; 95% confidence interval (CI) = 1.153-17.570] and estimated glomerular filtration rate < 30 mL/minute/1.73 m(2) (OR = 4.876; 95% CI = 1.112-21.374) as independent risk factors.

Conclusion: Postoperative VT/VF was rare after OPCAB but was associated with high mortality. Prolonged corrected QT interval and chronic kidney disease were independent risk factors. Recognition of these risk factors, proper prevention, and early intervention may improve survival.

Keywords: chronic kidney disease; off-pump coronary artery bypass; ventricular arrhythmia.

MeSH terms

Adult
Aged
Aged, 80 and over
Coronary Artery Bypass, Off-Pump / adverse effects*
Female
Hospital Mortality*
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Postoperative Complications / mortality*
ROC Curve
Retrospective Studies
Risk Assessment
Risk Factors
Tachycardia, Ventricular / mortality*
Taiwan
Ventricular Fibrillation / mortality*