Low-risk profile for malignant ventricular arrhythmias and sudden cardiac death after surgical ventricular reconstruction.
BACKGROUND
Although it has been recently demonstrated that there was no significant difference in total survival and clinical outcomes between patients who underwent coronary artery bypass grafting (CABG) with or without surgical ventricular reconstruction (SVR), the question of whether or not SVR decreases the arrhythmic risk profile in this population has not been clarified yet.


OBJECTIVE
To determine the real incidence of sudden cardiac death (SCD) and sustained ventricular tachycardia/ventricular fibrillation (sustained VT/VF) in patients following CABG added to SVR and to define their clinical and echocardiographic parameters predicting in-hospital and long-term arrhythmic events (SCD + sustained VT/VF).


METHODS
Pre- and postoperative clinical and echocardiographic values as well as postoperative electrocardiogram Holter data of 65 patients (21 female, 63 ± 11 years) who underwent SVR + CABG were retrospectively evaluated.


RESULTS
Mean follow-up was 1,105 ± 940 days. At 3 years, the SCD-free rate was 98% and the rate free from arrhythmic events was 88%. Multivariate logistic analysis identified a preoperative left ventricular end-systolic volume index (LVESVI) > 102 mL/m(2) (odds ratio [OR] 1.4, confidence interval [CI] 1.073-1.864, P = 0.02; sensitivity 100%, specificity 94%) and a postoperative pulmonary artery systolic pressure (PASP) > 27 mmHg (OR 2.3, CI 1.887-4.487, P = 0.01; sensitivity 100%, specificity 71%) as independent predictors of arrhythmic events.


CONCLUSIONS
Our and previous studies report a low incidence of arrhythmic events in patients following SVR added to CABG, considering the high-risk profile of the study population. A preoperative LVESVI > 102 mL/m(2) and a postoperative PASP > 27 mmHg had a good sensitivity and specificity in predicting arrhythmic events.
Baravelli
Massimo
M
Department of Cardiology and Intensive Cardiac Rehabilitation, Multimedica Holding, Castellanza, Varese, Italy. massimo.baravelli@virgilio.it
Cattaneo
Paolo
P
Rossi
Andrea
A
Rossi
Maria Cristina
MC
Fantoni
Cecilia
C
Picozzi
Anna
A
Imperiale
Daniela
D
Romano
Melania
M
Saporiti
Lucia
L
Bregasi
Alda
A
Menicanti
Lorenzo
L
Anzà
Claudio
C
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000453:epidemiology*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000453:epidemiology*