title: Low-risk profile for malignant ventricular arrhythmias and sudden cardiac death after surgical ventricular reconstruction.
abstract: 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.
authors.affiliation: Department of Cardiology and Intensive Cardiac Rehabilitation, Multimedica Holding, Castellanza, Varese, Italy. massimo.baravelli@virgilio.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Baravelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Cattaneo
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Rossi
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fantoni
authors.forename: Anna
authors.initials: A
authors.lastname: Picozzi
authors.forename: Daniela
authors.initials: D
authors.lastname: Imperiale
authors.forename: Melania
authors.initials: M
authors.lastname: Romano
authors.forename: Lucia
authors.initials: L
authors.lastname: Saporiti
authors.forename: Alda
authors.initials: A
authors.lastname: Bregasi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
authors.forename: Claudio
authors.initials: C
authors.lastname: Anzà
mesh_terms: 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*