[Management of lethal ventricular arrhythmias after cardiac surgery].
Arrhythmias are commonly occur after cardiac surgery. Recurrent sustained ventricular tachycardia and ventricular fibrillation in the acute phase after cardiac surgery is the most lethal arrhythmia and may warrant acute intervention and aggressive treatment. Although class I agents are usually ineffective and exacerbate the heart failure in cases with a low ejection fraction, nifekalant(a newer class III agent) and amiodarone can be effective. Hemodynamically tolerable sustained monomorphic ventricular tachycardia can be successfully terminated with ramp or burst pacing via an epicardial ventricular pacing lead. Initiation of intra-aortic balloon pumping and emergency percutaneous cardiopulmonary bypass and emergency catheter ablation can be considered for those patients not responding to the conventional resuscitative measures.
Department of Cardiovascular Medicine, Kanto Medical Center, Nippon Telegraph and Telephone East Corporation.
Satoshi
S
Ohnishi
D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D017115:Catheter Ablation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D011183:Postoperative Complications / Q000628:therapy*; D011744:Pyrimidinones / Q000627:therapeutic use; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000628:therapy*
D000889:Anti-Arrhythmia Agents; D011744:Pyrimidinones; C076259:nifekalant; D000638:Amiodarone