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CARDIOVASCULAR ANESTHESIA

The Incidence and Outcome of Ventricular Arrhythmias After Noncardiac Thoracic Surgery

David Amar, MD^*, Hao Zhang, MD^*, and Nancy Roistacher, MD

Departments of *Anesthesiology and Critical Care Medicine, and Medicine, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York

Address correspondence and reprint requests to David Amar, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., M-304, New York, NY 10021. Address e-mail to amard{at}mskcc.org

Atrial arrhythmias are common after thoracic surgery, but the incidence and significance of ventricular arrhythmias early after such surgery are not well established. Our goal was to determine the incidence and outcome of this complication from a continuing prospective database in 412 patients who had lobectomy (n = 243) or pneumonectomy (n = 169) and were continuously monitored with Holter recorders for 72–96 h postoperatively. The primary end point of the study was the occurrence of ventricular tachycardia (VT) defined as three or more consecutive wide complexes. Sixty-one of 412 patients (15%) developed 1 or more episode of VT. There were no episodes of sustained (>30 s) VT and no patient required treatment for hemodynamic compromise associated with any VT episode. Patients with VT had a more frequent incidence of a preoperative left bundle branch block (P = 0.01) but did not differ in other clinical characteristics, operative data, or core temperature on arrival to the postanesthesia care unit, when compared with those without VT. Patients who developed VT had significantly more atrial premature contractions (P < 0.001), ventricular premature contractions (P < 0.001), ventricular couplets (P < 0.001), and postoperative atrial fibrillation, 21 of 61 (34%) versus 58 of 351 (17%), P = 0.001, than those without VT, respectively. Multivariate logistic regression analysis revealed that only postoperative atrial fibrillation occurrence was independently associated with VT (relative risk 2.6, 95% confidence intervals 1.4 to 4.8, P = 0.002). We conclude that nonsustained VT after noncardiac thoracic surgery occurs frequently but is not associated with poor outcome. The strong association of atrial and ventricular arrhythmogenesis with VT suggests that vagal withdrawal and/or adrenergic hyperactivity may have a role in precipitating these events in the early postoperative period.

IMPLICATIONS: In 412 patients, we determined that the incidence of nonsustained ventricular tachycardia after major thoracic surgery is 15% and is not associated with poor outcome.

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