Predictors and frequency of conduction disturbances after open-heart surgery

Emkanjoo, Z. and Mirza-Ali, M. and Alizadeh, A. and Hosseini, S. and Jorat, M.V. and Nikoo, M.H. and Sadr-Ameli, M.A. (2008) Predictors and frequency of conduction disturbances after open-heart surgery. Indian Pacing and Electrophysiology Journal, 8 (1). pp. 14-21.

Predictors and frequency of conduction disturbances after open-heart surgery.pdf

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Introduction: The risk of developing conduction disturbances after coronary bypass grafting (CABG) or valvular surgery has been well established in previous studies, leading to permanent pacemaker implantation in about 2 to 3 of patients, and in 10 of patients undergoing repeat cardiac surgery. We sought to determine the incidence, features and predictors of conduction disorders in the immediate post-operative period of patients subjected to open-heart surgery, and the need for permanent pacemaker implantation. Material and Method: We prospectively studied 374 consecutive patients who underwent open-heart surgery in our institution: coronary artery bypass (CABG) (n=128), Mitral valve replacement(MVR) (n=18), aortic valve replacement(AVR) (n=21), MVR and AVR(n=56), repair of ventricular septal defect (VSD) (n=51), repair of tetralogy of Fallot (TOF) (n=57),CABG and valvular surgery (n=6), others (n=37). Results: Among 374 patients included in our study (mean age 34.46±25.68; 146 males), 192 developed new conduction disorders: symptomatic sinus bradycardia in 8, atrial fibrillation with slow ventricular response (AF) in 4.5, first-degree atrioventricular block (AVB)in 6.4, second-degree AVB in 0.3 third-degree AVB in 7, new right bundle branch block (RBBB) in 33, and new left bundle branch block (LBBB) in 2.1. In 5.6 patients, a permanent pacemaker was implanted, 47.6 of them underwent valvular surgery. In 44.1 of patients the conduction defects occurred in the first 48 hr. after surgery. In CABG group, 29.7 of patients developed new conduction disturbances; the most common of them was symptomatic sinus bradycardia. After valvular surgery 44.2 of patients developed conduction disturbances, of those the most common was atrial fibrillation with slow ventricular response. After VSD and TOF repair, the most common conduction disturbance was new RBBB. Perioperative myocardial infarction (MI) occurred in 1.9 of patients. The occurrence conduction disturbance was compared with patient age, sex, occurrence of perioperative MI, ejection fraction (EF), postoperative use of �-adernergic receptor blocking agents and digitalis and type of cardiac surgery. By regression analysis there was a correlation between type of surgery and new conduction defects, being significant for CABG and TOF repair. Only the occurrence of perioperative MI was related to PPM implantation. Conclusion: Irreversible AVB requiring a PPM is an uncommon complication after open-heart surgery. Peri-operative MI is a risk factor.

Item Type: Article
Additional Information: cited By 9
Uncontrolled Keywords: antiarrhythmic agent; beta adrenergic receptor blocking agent; calcium channel blocking agent; digoxin, adult; aorta valve replacement; article; artificial heart pacemaker; clinical feature; complete heart block; coronary artery bypass graft; correlation analysis; female; first degree atrioventricular block; frequency analysis; heart atrium fibrillation; heart infarction; heart left bundle branch block; heart left ventricle ejection fraction; heart muscle conduction disturbance; heart right bundle branch block; heart valve surgery; human; incidence; major clinical study; male; mitral valve replacement; open heart surgery; peroperative complication; postoperative complication; prediction; risk factor; second degree atrioventricular block; sinus bradycardia
Subjects: WO Surgery
WG Cardiovascular System
Depositing User: Arezoo Ghasemi siani
Date Deposited: 14 Dec 2020 08:01
Last Modified: 14 Dec 2020 08:01

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