[Coronary revascularization in patients with preoperative electrical storm].
We report 5 cases who underwent surgical coronary revascularization for subacute myocardial ischemia with preoperative electrical storm. All patients showed severe left ventricular dysfunction. Mean ejection fraction was 24.4 +/- 7.6%. Three patients had already had implantable cardioverter-defibrillator (ICD) therapy. Procedures were on-pump coronary artery bypass grafting (CABG) and mitral valvuloplasty (MVP) [case 1], on-pump CABG, MVP, left ventricular restoration (LVR) and cryoablation (case 2), and off-pump CABG (case 3-5). Case 5 necessitated conversion to on-pump for electrical storm during left circumflex artery (LCx) anastomosis. Case 3 suddenly died on the 2nd postoperative day due to electrical storm. Case 1 had recurrent attack of electrical storm postoperatively, treated by ICD, overdrive pacing, repeated intraaortic balloon pumping (IABP), deep sedation with endotracheal intubation, and finally catheter ablation. Four patients have survived 2 years (mean) postoperatively without any arrhythmia, and are all in good condition [New York Heart Association (NYHA) I] now. It was concluded that off-pump procedure was not suitable for subacute myocardial ischemia with electrical storm and that LVR with surgical cryoablation would be effective if indicated.
Kawashima
Toshiya
T
Department of Cardiovascular Surgery, Caress Sapporo Hokko Memorial Hospital, Sapporo, Japan.
Naraoka
S
S
D000368:Aged; D001026:Coronary Artery Bypass; D017147:Defibrillators, Implantable; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000209:etiology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery; D014693:Ventricular Fibrillation / Q000209:etiology