Risk factors and outcome of new-onset cardiac arrhythmias in vascular surgery patients

Autor: Sanne E. Hoeks, Jeroen J. Bax, Tamara A. Winkel, Paulus Kirchhof, Hence J.M. Verhagen, Don Poldermans, Dave Hampton, Olaf Schouten, Jan-Peter van Kuijk, Willem-Jan Flu, Jan Lindemans
Přispěvatelé: Surgery, Anesthesiology, Clinical Chemistry
Rok vydání: 2010
Předmět:
Male
medicine.medical_specialty
Time Factors
Heart disease
Ischemia
Ventricular tachycardia
Disease-Free Survival
Heart Rate
Risk Factors
Internal medicine
medicine
Humans
Vascular Diseases
cardiovascular diseases
Intraoperative Complications
Aged
Netherlands
Retrospective Studies
medicine.diagnostic_test
business.industry
Incidence
intensive-care-unit atrial-fibrillation postoperative arrhythmias noncardiac surgery supraventricular tachyarrhythmias ventricular-tachycardia surgical-patients heart recommendations quantification
Arrhythmias
Cardiac
Atrial fibrillation
Perioperative
Prognosis
medicine.disease
Survival Rate
Ventricular fibrillation
Electrocardiography
Ambulatory
cardiovascular system
Cardiology
Female
Supraventricular tachycardia
Cardiology and Cardiovascular Medicine
business
Vascular Surgical Procedures
Electrocardiography
Follow-Up Studies
Zdroj: American Heart Journal, 159(6), 1108-1115. Mosby Inc.
American Heart Journal, 159(6), 1108-1115
ISSN: 0002-8703
Popis: Background The pathophysiology of new-onset cardiac arrhythmias is complex and may bring about severe cardiovascular complications. The relevance of perioperative arrhythmias during vascular surgery has not been investigated. The aim of this study was to assess risk factors and prognosis of new-onset arrhythmias during vascular surgery. Methods A total of 513 vascular surgery patients, without a history of arrhythmias, were included. Cardiac risk factors, inflammatory status, and left ventricular function (LVF; N-terminal pro-B-type natriuretic peptide and echocardiography) were assessed. Continuous electrocardiography (ECG) recordings for 72 hours were used to identify ischemia and new-onset arrhythmias: atrial fibrillation, sustained ventricular tachycardia, supraventricular tachycardia, and ventricular fibrillation. Logistic regression analysis was applied to identify preoperative risk factors for arrhythmias. Cox regression analysis assessed the impact of arrhythmias on cardiovascular event-free survival during 1.7 years. Results New-onset arrhythmias occurred in 55 (11%) of 513 patients: atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, and ventricular fibrillation occurred in 4%, 7%, 1%, and 0.2%, respectively. Continuous ECG showed myocardial ischemia and arrhythmias in 17 (3%) of 513 patients. Arrhythmia was preceded by ischemia in 10 of 55 cases. Increased age and reduced LVF were risk factors for the development of arrhythmias. Multivariate analysis showed that perioperative arrhythmias were associated with long-term cardiovascular events, irrespective of the presence of perioperative ischemia (hazard ratio 2.2, 95% CI 1.3-3.8, P=.004). Conclusion New-onset perioperative arrhythmias are common after vascular surgery. The elderly and patients with reduced LVF show arrhythmias. Perioperative continuous ECG monitoring helps to identify this high-risk group at increased risk of cardiovascular events and death. (Am Heart J 2010;159:1108-15.)
Databáze: OpenAIRE
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