Transmyocardial laser revascularization and left ventricular reduction surgery affect ventricular arrhythmias and heart rate variability.
BACKGROUND
Transmyocardial laser revascularization (TMLR) and left ventricular reduction by endoventricular patch plasty (LVR) are 2 new surgical procedures performed in patients with endstage coronary artery disease and left ventricular dilation/aneurysms, respectively. As these are performed in patients at high risk for sudden cardiac death and may interact with arrhythmogenesis, we assessed the influence of these procedures on incidence and severity of ventricular tachyarrhythmias and time-domain heart rate variability.


METHODS
Preoperative and one week postoperative 24-hour Holter recordings were performed in 37 patients undergoing TMLR (n = 23, CO2-laser technique) or LVR (n = 14).


RESULTS
TMLR patients received a mean of 27.2 +/- 9.2 laser channels. Postoperatively, the proportion of patients who underwent TMLR with spontaneous ventricular tachycardia (> or =4 repetitive ventricular beats) increased (0% vs 26%, P <.05), including one patient who died from documented ventricular fibrillation during monitoring. There was no correlation to the number and/or location of laser-induced channels or to perioperative CK levels. HRV parameters were not altered by TMLR. By contrast, LVR did not significantly influence ventricular tachyarrhythmia episodes but markedly depressed all major HRV parameters (SDNN 116.4 vs 61.8, RMSSD 35.2 vs 19.9, pNN50 14.5 vs 4.9, all P <.05).


CONCLUSIONS
Early after TMLR, there is evidence of an increased incidence of spontaneous ventricular tachycardia enhancing the risk for sudden cardiac death, while HRV remains unaffected. By contrast, LVR resulted in a marked reduction in HRV still present one week postoperatively, while no effect was observed on incidence and/or severity of spontaneous ventricular tachyarrhythmias.
Brunner
Michael
M
Innere Medizin III-Kardiologie und Angiologie, Universitätsklinik Freiburg, Freiburg, Germany. brunner@mm31.ukl.uni-freiburg.de
Hess
Barbara
B
Lutter
Georg
G
Zipfel
Martina
M
Grom
Andreas
A
Beyersdorf
Friedhelm
F
Bode
Christoph
C
Zehender
Manfred
M
D000368:Aged; D003327:Coronary Disease / Q000601:surgery*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006322:Heart Aneurysm / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000401:mortality; D018879:Ventricular Premature Complexes / Q000209:etiology