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Eur J Cardiothorac Surg 1998;13:629-636
© 1998 Elsevier Science NL

Venticular arrhythmia following successful myocardial revascularization: incidence, predictors and prevention

Department of Cardiac Surgery, Baptist Medical Center, Birmingham, AL, USA

Received 28 September 1997; received in revised form 16 March 1998; accepted 24 March 1998.

Corresponding author. Suite 300, Cardiac Surgery, 817 Princeton Avenue SW, Birmingham, AL 35211, USA. Fax: +1 151 2593870.

Objectives: We estimated the risk of sudden cardiac death (SCD), from a spontaneous episode of ventricular arrhythmia (VT/VF), after a successful surgical myocardial revascularization (coronary artery bypass grafting; CABG) procedure. Predictors of these events were identified, and long term benefits of the prophylactic regimes, that were used to control these events, were evaluated. Methods: We selected 8642 consecutive patients, who had undergone an isolated and first time CABG procedure, between 1/3/1980 and 1/3/1995. A standard hazard function model (1) was used for statistical analysis. Efficacy of the prophylactic regimes, was examined in a group of 350 high risk patients, with a preoperative left ventricular ejection fraction 30% or less, who were recently operated since 1/1/1988. Electrophysiologic (EP) guided prophylaxis was used in 92 (26%) patients, who had survived a documented episode of SCD, and remaining 258 patients were maintained on antiarrhythmic medication on an empirical basis. A sequential EP evaluation was performed, when indicated. Results: During an early phase of hazard, which mainly lasted for up to 3 months after CABG, incremental risk factors were preoperative LVEF 30% or less (P=0.0007) and preoperative episodes of VT/VF (P=0.04). This phase was followed by a constant phase with a low risk of the events, which merged into a slowly rising late phase after 6 years. EP guided prophylaxis, reduced the risk of SCD in high risk patients (P=0.03). A sequential EP evaluation, helped to detect the problems of drug resistance and a cross over from non-sustained to sustained runs of VT/VF. Conclusions: Despite a successful CABG surgery, risk of VT/VF persists. A routine EP evaluation before and after a CABG procedure is recommended in all patients with a poor left ventricular function.

Key Words: Sudden cardiac death • Ventricular arrhythmias • Coronary artery bypass grafting