Perioperative and postoperative arrhythmia in three-vessel coronary artery disease patients and antiarrhythmic effects of ischemic preconditioning.
OBJECTIVE
Sudden cardiac death caused by arrhythmia remains a major unsolved problem after coronary artery bypass grafting (CABG). Ischemic preconditioning (IP) has proved effective in suppressing ischemia reperfusion arrhythmias in animals and humans. The purpose of the present study was to establish whether IP reduces postoperative arrhythmias in three-vessel coronary artery disease patients undergoing CABG.


METHODS
Forty-five patients with stable angina and three main coronary artery stenosis admitted for primary CABG surgery were randomized into an IP and a control group. The IP protocol entailed twice occluding the ascending aorta by cross-clamping for 2 min, followed by 3 min of reperfusion. Electrocardiography was continuously recorded from the day before surgery to the second postoperative day.


RESULTS
During the recording, all patients developed SVES and VES after the operation. The incidences of SVT and ventricular tachycardia (VT) after surgery were 73.3 and 77.8%, respectively. IP significantly reduced VES events per hour during 2h after reperfusion. The SVT and VT incidence and events per hour were significantly lower in the IP group during 2h after reperfusion and 24h later.


CONCLUSIONS
IP significantly reduced VES, SVT, and VT after surgery. The antiarrhythmic effect 24h after surgery indicates a delayed antiarrhythmic IP phenomenon in these patients. These findings would indicate that IP constitutes a potential additional myocardial protective strategy in multi-vessel diseased patients undergoing CABG.
Wu
Zhong-Kai
ZK
Division of Cardiac Surgery, Department of Surgery, Tampere University Hospital, 33521 Tampere, Finland.
Iivainen
Tiina
T
Pehkonen
Erkki
E
Laurikka
Jari
J
Tarkka
Matti R
MR
D000368:Aged; D001011:Aorta; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery* / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D018709:Statistics, Nonparametric