Risk factors and outcome of new-onset cardiac arrhythmias in vascular surgery patients.
BACKGROUND
The pathophysiology of new-onset cardiac arrhythmias is complex and may bring about severe cardiovascular complications. The relevance of perioperative arrhythmias during vascular surgery has not been investigated. The aim of this study was to assess risk factors and prognosis of new-onset arrhythmias during vascular surgery.


METHODS
A total of 513 vascular surgery patients, without a history of arrhythmias, were included. Cardiac risk factors, inflammatory status, and left ventricular function (LVF; N-terminal pro-B-type natriuretic peptide and echocardiography) were assessed. Continuous electrocardiography (ECG) recordings for 72 hours were used to identify ischemia and new-onset arrhythmias: atrial fibrillation, sustained ventricular tachycardia, supraventricular tachycardia, and ventricular fibrillation. Logistic regression analysis was applied to identify preoperative risk factors for arrhythmias. Cox regression analysis assessed the impact of arrhythmias on cardiovascular event-free survival during 1.7 years.


RESULTS
New-onset arrhythmias occurred in 55 (11%) of 513 patients: atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, and ventricular fibrillation occurred in 4%, 7%, 1%, and 0.2%, respectively. Continuous ECG showed myocardial ischemia and arrhythmias in 17 (3%) of 513 patients. Arrhythmia was preceded by ischemia in 10 of 55 cases. Increased age and reduced LVF were risk factors for the development of arrhythmias. Multivariate analysis showed that perioperative arrhythmias were associated with long-term cardiovascular events, irrespective of the presence of perioperative ischemia (hazard ratio 2.2, 95% CI 1.3-3.8, P = .004).


CONCLUSIONS
New-onset perioperative arrhythmias are common after vascular surgery. The elderly and patients with reduced LVF show arrhythmias. Perioperative continuous ECG monitoring helps to identify this high-risk group at increased risk of cardiovascular events and death.
Winkel
Tamara A
TA
Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands.
Schouten
Olaf
O
Hoeks
Sanne E
SE
Flu
Willem-Jan
WJ
Hampton
Dave
D
Kirchhof
Paulus
P
van Kuijk
Jan-Peter
JP
Lindemans
Jan
J
Verhagen
Hence J M
HJ
Bax
Jeroen J
JJ
Poldermans
Don
D
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014652:Vascular Diseases / Q000453:epidemiology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*