Arrhythmias and conduction disturbances after cardiac surgery.pptVIP

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Arrhythmias and conduction disturbances after cardiac surgery.ppt

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Arrhythmias and conduction disturbances after cardiac surgery

Arrhythmias and conduction disturbances after cardiac surgery Anjan Gupta M.D. Milwaukee Heart Institute University of Wisconsin, Milwaukeeanjangupta@pol.net Post cardiac surgery atrial arrhythmias INCIDENCE OF ATRIAL FIBRILLATION OR FLUTTER AFTER CABG INCIDENCE OF ATRIAL FIBRILLATION OR FLUTTER AFTER CABG Reference No. of Pts developing ECG Peak incidence atrial fibrillation and patients or flutter documentation (days postop) Year studied FACTORS ASSOCIATED WITH POST CABG ATRIAL FIBRILLATION AND FLUTTER PREOPERATIVE FACTORS FACTORS ASSOCIATED WITH POST CABG ATRIAL FIBRILLATION AND FLUTTER PREOPERATIVE FACTORS FACTORS ASSOCIATED WITH POST CABG ATRIAL FIBRILLATION AND FLUTTER PEROPERATIVE FACTORS FACTORS ASSOCIATED WITH POST CABG ATRIAL FIBRILLATION AND FLUTTER POSTOPERATIVE FACTORS SIGNIFICANT PREOPERATIVE PREDICTORS OF POSTOPERATIVE AFIB BY UNIVARIATE ANALYSIS MULTIVARIABLE PREDICTORS OF POSTOPERATIVE AFIB Length of stay in hospital after postop atrial arrhythmias Incidence of V-Fib, V-Tach and stroke associated with postop atrial arrhythmias Day of onset of atrial fibrillation after CABG Prevalence of A-fib according to age at operation Postoperative atrial fibrillation - Treatment Ibutilide - a new drug for atrial Fibrillation and Flutter Class III antiarrythmic drug In a randomized trial was proven to be superior to placebo in converting post op afib ( Kowey et al ) A-flutter responds better than A-fib Adverse effects include development of Torsades Atrial Fibrillation Ventricular Tachyarrhythmias Ventricular arrhythmias EPIDEMIOLOGIC FEATURES Ventricular ectopy, including NSVT is seen in about 50% of patients after cardiac surgery Sustained VT and ventricular fibrillation occur rarely after cardiac surgery (0.4 - 1.4% reported in various studies) Ventricular arrhythmias