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LETTERS TO THE EDITOR

Arrhythmias After Video Assist Thoracoscopy

Department of Anesthesiology Department of Cardiothoracic Surgery Department of Anesthesiology, Mt. Sinai School of Medicine, New York, NY

To the Editor:

We read with interest the article entitled "Thoracic Epidural Bupivacaine Attenuates Supraventricular Tachyarrhythmias After Pulmonary Resection" (1).

Almost all of our patients who are scheduled for thoracotomy receive epidural for postoperative analgesia. In addition to the improved pain control and improved pulmonary function postoperatively, a less frequent occurrence of arrhythmias is yet an additional reason that epidural analgesia should be provided. Some patients who undergo video-assisted thoracoscopy (VAT) also receive epidural catheters for postoperative pain management. This population was not addressed in the current study.

We would like to point out our previously published report that was not cited in your article (2). In our retrospective review, we reported a less frequent incidence of postoperative arrhythmias in patients who underwent VAT who received epidural analgesia compared with patients who did not have epidural analgesia. Of 51 patients who did not have epidural analgesia, 8 had postoperative supraventricular tachycardia, compared with 0 of 30 patients who had epidural analgesia. The use of epidural catheters for postoperative pain management is also beneficial in patients who have undergone VAT.

References

1. Oka T, Ozawa T, Ohkubo Y. Thoracic epidural bupivacaine attenuates supraventricular tachyarrhythmias after pulmonary resection. Anes Analg 2001; 93: 253–9.
2. Neustein SM, Kahn P, Krellenstein DJ, Cohen E. Incidence of arrhythmias after thoracic surgery: Thoracotomy versus video-assisted thorocotomy. J Cardiothor Vasc Anesth 1998; 12: 659–661.[Medline]

Response

Division of Anesthesia, Tochigi Cancer Center Hospital, Tochigi, Japan

In Response:

I thank Dr. Neustein for his comments regarding our study and appreciate the opportunity to reply. I read with interest the clinical report of Neustein et al. (1) describing arrhythmias after video-assisted thoracoscopy (VAT). I agree with Neustein et al. (1) that the incidence of postoperative arrhythmias was less frequent in patients who underwent VAT and received epidural analgesia compared with patients who did not have epidural analgesia. However, they reported that postoperative epidural analgesia did not affect the incidence of postoperative arrhythmias in the thoracotomy group. Moreover, their study did not assess the pain intensity. Therefore, I do not agree that only the pain relief by epidural analgesia decreased postoperative tachyarrhythmias. We indicated that the continuous infusion of thoracic epidural bupivacaine reduced supraventricular tachyarrhythmias compared with continuous epidural morphine infusion in postoperative periods, although there was no significant difference in pain intensity between the arrhythmias (+) group and arrhythmias (-) group (2).

They suggested that the incidence of postoperative arrhythmias was not statistically different between patients who underwent VAT and those who underwent thoracotomy, although all patients who had either pneumonectomy or lobectomy had a thoracotomy incision. Thoracotomy is one of the procedures associated with the most severe postoperative pain (3). The extent of pulmonary resection has been considered a risk factor of postoperative arrhythmias (4). Therefore, I suppose that this result may be caused by the difference in distribution of age between two groups.

Their study design was a retrospective investigation and the possible risk factors for postoperative arrhythmias were not assessed by a multivariate statistical analysis. A randomized controlled study is necessary to assess the effects of epidural analgesia on postoperative tachyarrhythmias after VAT.

References

1. Neustein SM, Kahn P, Krellenstein DJ, et al. Incidence of arrhythmias after thoracic surgery: Thoracotomy versus video-assisted thoracotomy. J Cardiothor Vasc Anesth 1998; 12: 659–61.
2. Oka T, Ozawa Y, Ohkubo Y. Thoracic epidural bupivacaine attenuates supraventricular tachyarrhythmias after pulmonary resection. Anest Analg 2001; 93: 253–9.[Abstract/Free Full Text]
3. Borgeat A, Petropoulos P, Cavin R, et al. Prevention of arrhythmias after noncardiac thoracic operations: flecainide versus digoxin. Ann Thorac Surg 1991; 51: 964–8.[Abstract]
4. Asamura H, Naruke T, Tsuchiya R, et al. What are the risk factors for arrhythmias after thoracic operations? J Thorac Cardiovasc Surg 1993; 106: 1104–10.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Neustein, S. M. Articles by Oka, T. Search for Related Content PubMed PubMed Citation Articles by Neustein, S. M. Articles by Oka, T.