Published online before print November 18, 2002, doi: 10.1161/01.CIR.0000041430.32233.5B
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(Circulation. 2002;106:3091.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Ischemic Preconditioning Suppresses Ventricular Tachyarrhythmias After Myocardial Revascularization
From the Division of Cardiac Surgery, Department of Surgery (Z.-K.W., E.P., J.L., M.R.T.) and Department of Clinical Physiology (T.I.), Tampere University Hospital, Tampere, Finland.
Correspondence to Matti Tarkka, MD, Clinic of Cardiac Surgery, Tampere University Hospital, 33521 Tampere, Finland. E-mail matti.tarkka{at}tays.fi
Background— Ventricular fibrillation (VF) and tachycardia (VT) are the common and potential life-threatening complications after CABG. Ischemic preconditioning (IP) has been proved effective in reducing ischemia reperfusion arrhythmia in animals and humans. Whether IP is effective in suppressing postoperative VF/VT in patients with CABG has not been studied.
Methods and Results— Eighty-six patients with CABG with stable and unstable 3-vessel disease were equally randomly assigned into an IP and a control group. The patients who received IP received 2 periods of 2-minute ischemia followed by 3-minute reperfusion. Twenty-four-hour electrocardiographic data were collected. IP resulted in fewer cases of VF after declamping (48.8% versus 79.1% in IP and control, P=0.004) and a shorter VF period (2.28±0.44 versus 4.41±0.51 minutes, P=0.002). The episodes of VT were significantly reduced in patients in the IP group during early reperfusion and 24 hours after reperfusion (0.65±0.16 versus 3.71±0.46, P=0.000 and 0.07±0.04 versus 2.12±1.41, P=0.002, respectively). De novo sustained VT occurred in 3 control patients as against none in the IP group after surgery. As a result, IP significantly curtailed the mechanical ventilation period and reduced the need for inotropes.
Conclusions— IP significantly reduced postoperative VF/VT in patients with CABG with 3-vessel disease. Suppression of VT during early reperfusion and 24 hours after reperfusion suggests early and delayed IP phenomena in patients undergoing CABG surgery.
Key Words: ischemia • ventricles • tachycardia • fibrillation • reperfusion
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Circulation 2002 106: 2999-3001.
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