(Circulation. 1999;99:903-908.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
New-Onset Sustained Ventricular Tachycardia After Cardiac Surgery
From the Division of Cardiology, Department of Medicine, St Luke's–Roosevelt Hospital Center, and Columbia University College of Physicians and Surgeons, New York, NY.
Background—The de novo occurrence of sustained ventricular tachycardia (VT) after CABG has been described, but the incidence, mortality rate, long-term follow-up, and mechanism are not well defined.
Methods and Results—This prospective study enrolled
consecutive patients undergoing CABG at a single institution. Patients
were followed up for the development of sustained VT, and a detailed
analysis of clinical, angiographic, and surgical variables
associated with the occurrence of VT was performed. A total of 382
patients participated, and 12 patients (3.1%) experienced 
1 episode
of sustained VT 4.1±4.8 days after CABG. In 11 of 12 patients, no
postoperative complication explained the VT; 1 patient had a
perioperative myocardial infarction. The in-hospital
mortality rate was 25%. Patients with VT were more likely to have
prior myocardial infarction (92% versus 50%, P<0.01),
severe congestive heart failure (56% versus 21%,
P<0.01), and ejection fraction <0.40 (70% versus
29%, P<0.01). When all 3 factors were present, the
risk of VT was 30%, a 14-fold increase. Patients with VT had more
noncollateralized totally occluded vessels on angiogram (1.4±0.97
versus 0.54±0.7, P<0.01), a bypass graft across a
noncollateralized occluded vessel (1.50±1.0 versus 0.42±0.62,
P<0.01), and a bypass graft across a noncollateralized
occluded vessel to an infarct zone (1.50±1.0 versus 0.17±0.38,
P<0.01). By multivariate
analysis, the number of bypass grafts across a
noncollateralized occluded vessel to an infarct zone was the only
independent factor predicting VT.
Conclusions—The first presentation of sustained monomorphic VT in the recovery period after CABG is uncommon, but the incidence is high in specific clinical subsets. Placement of a bypass graft across a noncollateralized total occlusion in a vessel supplying an infarct zone was strongly and independently associated with the development of VT.
Key Words: bypass • surgery • tachyarrhythmias
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