title: Risk factors and outcome of new-onset cardiac arrhythmias in vascular surgery patients.
abstract: 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.
authors.affiliation: Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Tamara A
authors.initials: TA
authors.lastname: Winkel
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Flu
authors.forename: Dave
authors.initials: D
authors.lastname: Hampton
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: van Kuijk
authors.forename: Jan
authors.initials: J
authors.lastname: Lindemans
authors.forename: Hence J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: 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*