Postoperative XXXX after cardiac surgery: immediate- and long-term significance.

@entity1 @entity1479 @entity2643 @entity3044 @entity943
AF is frequent after cardiac surgery. However, @entity943 are less known. The purpose of the study was to evaluate the causes and the prognostic significance of severe @entity943 occurring after cardiac surgery. For 10 years, among 2,100 cardiac surgeries, 16 (0.8%) @entity1 (13 @entity1 , 3 @entity1 ; age 49-71 years, mean 62 +/- 9 years) without previous @entity943 , with preserved left ventricular ejection fraction, and without acute cause of @entity943 , developed VF (n = 4) or a sustained VT between 3 days and 3 weeks after cardiac surgery (coronary artery bypass grafting [n = 6], valve replacement [n = 10]). Rapid AF (n = 5) or slow AF (n = 1) were present at the time of VT/VF. Programmed ventricular stimulation occurred after up to three extrastimuli in the basal state and after infusion of 20-30 micrograms of @entity3044 . An echocardiogram, coronary angiography, Holter monitoring with heart rate variability (HRV) study were performed. Ventricular stimulation was negative in six @entity1 (with AF); sustained and clinical VT was induced in 10 @entity1 with a left ventricular ejection fraction > 0.40, except in one @entity1 . Valvular prothesis and coronary bypass graftings were normal. In all @entity1 , HRV was normal before surgery and decreased after cardiac surgery; before versus after surgery, respectively, HR 69 +/- 9 and 89 +/- 30 beats/min (P < 0.01), SDNN 117 +/- 31 and 50 +/- 11 ms (P < 0.001), low frequency (LF) 474 +/- 658 and 51 +/- 40 ms2 (P < 0.05), high frequency (HF) 115 +/- 23 and 33 +/- 32 ms2 (P < 0.05), LF:HF 4 +/- 3 and 1 +/- 0.6 (P < 0.01). Follow-up lasted from 6 months to 10 years (mean 3 +/- 2 years). In @entity1 without induced VT, 1 @entity1 died from asystole, 1 had an @entity1479 but no subsequent events, and the other 4 untreated @entity1 are free of events. @entity1 with induced VT were treated with @entity2643 and beta-blockers except in one @entity1 who died from extracardiac complications. Six of nine @entity1 had no inducible VT with this treatment and are alive; 3 @entity1 had inducible VT, 1 died suddenly before implantation of @entity1479 , and 2 @entity1 are alive with an @entity1479 ; recurrent VTs were noted in one @entity1 and received an @entity1479 . In conclusion, recent heart surgery may increase the risk of @entity943 . The reduction of indexes reflecting sympathetic and parasympathetic tone could facilitate the occurrence of @entity943 (and then VT) in @entity1 without ventricular arrhythmogenic substrate or the development of VT/VF in @entity1 with a latent previous ventricular arrhythmogenic substrate. In @entity1 without inducible VT, the prognosis is excellent and an @entity1479 is not recommended in these @entity1 . In those with inducible VT, there is a high incidence of responders to antiarrhythmic drugs with a favorable prognosis.
