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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 56-65, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
K Hashimoto, DM Ilstrup and HV Schaff
The influence of 45 variables on risk of postoperative supraventricular
tachycardia was evaluated by univariate and multivariate analysis of data
from 800 consecutive patients who underwent isolated coronary artery bypass
during a 6-year interval. Postoperative supraventricular arrhythmias
occurred in 186 patients (23%) but did not contribute to any of the six
early deaths (30-day mortality rate, 0.8%). Mean (+/- standard deviation)
length of hospital stay was longer (9.8 +/- 5.7 versus 8.3 +/- 3.5 days; p
less than 0.0001) and mean age was older (65 versus 60 years; p less than
0.002) in patients with postoperative supraventricular tachycardia than in
those with regular rhythm. Risk of supraventricular tachycardia was
increased in patients with a history of atrial arrhythmias (45% versus 22%;
p less than 0.002) or premature atrial contractions on the preoperative
electrocardiogram (48% versus 22%; p less than 0.002). Multiple logistic
regression analysis identified age 65 years or more, history of atrial
arrhythmia or preoperative premature atrial contractions, and preoperative
left ventricular end-diastolic pressure 20 mm Hg or more as independent
predictors of postoperative supraventricular tachycardia. Six percent of
patients converted to sinus rhythm spontaneously; 82% of patients converted
within 1.1 +/- 1.9 days after onset of supraventricular tachycardia on
treatment with digoxin or beta-adrenergic blocking drugs or both. Only 10%
of patients with supraventricular tachycardia required electrical
cardioversion. We conclude that the risk of supraventricular tachycardia
after coronary artery bypass is influenced by patient-related variables and
is effectively managed by conventional therapy. Prophylactic treatment
should be reserved for elderly patients, especially those who have atrial
arrhythmias or have preoperative left ventricular end-diastolic pressure 20
mm Hg or more.
ARTICLES
Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after coronary artery bypass
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905.
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