title: Comparison of the incidences of cardiac arrhythmias, myocardial ischemia, and cardiac events in patients treated with endovascular versus open surgical repair of abdominal aortic aneurysms.
abstract: This study examines differences in cardiac arrhythmias, perioperative myocardial ischemia, troponin T release, and cardiovascular events between endovascular and open repair of abdominal aortic aneurysms (AAAs). Of 175 patients, 126 underwent open AAA repair and 49 underwent endovascular AAA repair. Continuous 12-lead electrocardiographic monitoring, starting 1 day before surgery and continuing through 2 days after surgery, was used for cardiac arrhythmia and myocardial ischemia detection. Troponin T was measured on postoperative days 1, 3, and 7 and before discharge. Cardiac events (cardiac death or Q-wave myocardial infarction) were noted at 30 days and at follow-up (mean 2.3 years). New-onset atrial fibrillation, nonsustained ventricular tachycardia, sustained ventricular tachycardia, and ventricular fibrillation occurred in 5%, 17%, 2%, and 1% of patients, respectively. Myocardial ischemia, troponin T release, and 30-day and long-term cardiac events occurred in 34%, 29%, 6%, and 10% of patients, respectively. Significantly higher heart rates and less heart rate variability were observed in the open AAA repair group. Cardiac arrhythmias were less prevalent in the endovascular AAA repair group (14% vs 29%, p = 0.04). Endovascular repair was also significantly associated with less myocardial ischemia (odds ratio 0.14, 95% confidence interval 0.05 to 0.40, p <0.001) and troponin T release (odds ratio 0.10, 95% confidence interval 0.02 to 0.32, p <0.001) and lower 30-day mortality (zero vs 8.7%, p = 0.03) and 30-day cardiac event rates (zero vs 7.9%, p = 0.04). Long-term mortality and cardiac event rates were not significantly lower in the endovascular AAA repair group. In conclusion, endovascular AAA repair is associated with a lower incidence of perioperative cardiac arrhythmias, myocardial ischemia, troponin T release, cardiac events, and all-cause mortality compared with open AAA repair.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Harm H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Stefanos
authors.initials: S
authors.lastname: Karagiannis
authors.forename: Radosav
authors.initials: R
authors.lastname: Vidakovic
authors.forename: Peter G
authors.initials: PG
authors.lastname: Noordzij
authors.forename: Jasper J
authors.initials: JJ
authors.lastname: Brugts
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Marc R H M
authors.initials: MR
authors.lastname: van Sambeek
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology*; D011446:Prospective Studies; D015607:Stents; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D014656:Vascular Surgical Procedures
chemical_list: D020107:Troponin T