title: Ventricular arrhythmia after cardiac surgery: incidence, predictors, and outcomes.
abstract: OBJECTIVE
  This study sought to investigate the prevalence, predictors, and outcomes of patients with post-operative ventricular arrhythmia (POVA) in a large cohort of patients.
  
  
  BACKGROUND
  New-onset POVA after cardiac surgery (CS) is uncommon and has controversial prognostic value.
  
  
  METHODS
  A total of 14,720 consecutive patients undergoing CS at Emory University between January 2004 and July 2010 were included in the study. Data on all-cause mortality were obtained from Social Security Administration death records. Multivariable regression models were constructed to determine the risk factors for POVA and to estimate the independent impact of POVA on long-term survival after adjusting for 40 different covariates.
  
  
  RESULTS
  POVA occurred in 248 patients (1.7%). Patients with POVA were older (63.5 vs. 61.6 years), had lower left ventricular ejection fraction (EF) (43.7 vs. 51.3), and had greater comorbidities (Society of Thoracic Surgeons mortality risk score of 7.2% vs. 3.1%, p < 0.001). Multivariable analysis showed that older age (odds ratio [OR]: 1.018 per 1-year increase, p < 0.001), emergent surgery (OR: 1.77, p = 0.019), and the presence of PVD (OR: 1.41, p = 0.049) were associated with a higher incidence of POVA, whereas higher left ventricular EF (OR: 0.97 per 1% increase, p < 0.001), mild chronic obstructive pulmonary disease (OR: 0.37, p < 0.001), and off-pump surgery (OR: O.41, p < 0.001) were associated with a lower incidence of POVA. POVA was associated with substantially increased adjusted long-term mortality (hazard rate: 2.53, p < 0.001) over 3.5 years of follow-up.
  
  
  CONCLUSIONS
  POVA is associated with increased long-term mortality after CS. Older age, PVD, lower EF, and emergent surgery are associated with a higher risk of POVA, whereas off-pump surgery seems to be protective.
authors.affiliation: Division of Cardiology, Emory University, Atlanta, Georgia 30308, USA. melcham@emory.edu
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
authors.forename: Fadi J
authors.initials: FJ
authors.lastname: Sawaya
authors.forename: Patrick
authors.initials: P
authors.lastname: Kilgo
authors.forename: William
authors.initials: W
authors.lastname: Stein
authors.forename: Michael
authors.initials: M
authors.lastname: Halkos
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.forename: Omar M
authors.initials: OM
authors.lastname: Lattouf
authors.forename: David B
authors.initials: DB
authors.lastname: Delurgio
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Angel R
authors.initials: AR
authors.lastname: Leon
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors