[Preoperative risk assessment: long-term electrocardiography for directed diagnosis of arrhythmias].
The role of ambulatory electrocardiography for detection, confirmation, or exclusion of severe forms of arrhythmias was investigated in our preoperative anesthesia clinic. In a prospective study over a period of 21 months, 30 of 8935 preoperatively evaluated patients (0.3%) scheduled for noncardiac surgery were monitored by 24-h ambulatory ECG. Indications included common clinical reasons for ordering an ambulatory ECG and additional specific "anesthesiologic" indications: Syncopes, dizziness, or other manifestations possibly related to cardiac arrhythmias; Rhythm disturbances under antiarrhythmic drug therapy; Suspected paroxysms of supraventricular tachycardia; Q-T syndrome, R- on-T phenomenon; Insignificant rhythm disturbances in patients with significant cardiac disease such as cardiomyopathy, aortic stenosis, mitral valve prolapse; Rhythm disturbances in patients with poor general medical status; Recent myocarditis with arrhythmias; Previous known or suspected intraoperative cardiac complications; Suspected sick sinus syndrome. The mean age of the patients was 63.9 years; most (24/30) were classified as ASA III. In 4 patients with suspected bradycardic rhythm disturbances the ambulatory ECG proved a useful method for further decision-making compared to the routine resting ECG. According to the long-term ECG recordings 22 patients were classified as Lown IV. After effective antiarrhythmic therapy--usually with propafenon--none of these patients (n = 13) or those classified as Lown 0 to III (n = 8) showed intraoperative arrhythmias or other hemodynamic problems. In contrast, of the patients with complex rhythm disturbances refractory to antiarrhythmic drug therapy (n = 4) or those in whom emergency operations were performed without antiarrhythmic drug therapy (n = 2), 4 developed severe arrhythmias or other intraoperative hemodynamic problems. Two died on the 1st postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)
Metzler
H
H
Klinik für Anaesthesiologie, Universität Graz.
Rehak
P
P
Mahla
E
E
Rotman
B
B
List
W F
WF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012306:Risk; D013997:Time Factors
Präoperative Risikoerfassung: Langzeitelektrokardiographie zur gezielten Arrhythmiediagnostik.