Perioperative and postoperative arrhythmia in three-vessel coronary artery disease patients and antiarrhythmic effects of ischemic preconditioning

• Published in: European journal of cardio-thoracic surgery 2003-04, Vol.23 (4), p.578-584
• Main Authors: Wu, Zhong-Kai, Iivainen, Tiina, Pehkonen, Erkki, Laurikka, Jari, Tarkka, Matti R.
• Format: Article
• Language: English
• Subjects: Aged; Aorta; Arrhythmia; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - prevention & control; Biological and medical sciences; Cardiopulmonary Bypass; Chi-Square Distribution; Coronary Artery Bypass; Coronary artery bypass grafting; Coronary Disease - complications; Coronary Disease - surgery; Coronary Disease - therapy; Electrocardiography; Female; Humans; Intraoperative Period; Ischemic preconditioning; Ischemic Preconditioning, Myocardial - methods; Ligation; Male; Medical sciences; Middle Aged; Myocardial protection; Postoperative Period; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(03)00007-1

Objective: Sudden cardiac death caused by arrhythmia remains a major unsolved problem after coronary artery bypass grafting (CABG). Ischemic preconditioning (IP) has proved effective in suppressing ischemia reperfusion arrhythmias in animals and humans. The purpose of the present study was to establish whether IP reduces postoperative arrhythmias in three-vessel coronary artery disease patients undergoing CABG. Methods: Forty-five patients with stable angina and three main coronary artery stenosis admitted for primary CABG surgery were randomized into an IP and a control group. The IP protocol entailed twice occluding the ascending aorta by cross-clamping for 2 min, followed by 3 min of reperfusion. Electrocardiography was continuously recorded from the day before surgery to the second postoperative day. Results: During the recording, all patients developed SVES and VES after the operation. The incidences of SVT and ventricular tachycardia (VT) after surgery were 73.3 and 77.8%, respectively. IP significantly reduced VES events per hour during 2 h after reperfusion. The SVT and VT incidence and events per hour were significantly lower in the IP group during 2 h after reperfusion and 24 h later. Conclusions: IP significantly reduced VES, SVT, and VT after surgery. The antiarrhythmic effect 24 h after surgery indicates a delayed antiarrhythmic IP phenomenon in these patients. These findings would indicate that IP constitutes a potential additional myocardial protective strategy in multi-vessel diseased patients undergoing CABG.