Asymptomatic Perioperative Arrhythmias Linked to Sudden Death

A new study suggests that the use of preemptive implantable cardiac defibrillators (ICDs) could capture more episodes of new-onset ventricular tachyarrhythmia (VT), which in turn could enhance detection of those at highest risk of sudden death.

Researchers at Erasmus Medical Center (Rotterdam, The Netherlands) examined data from 483 vascular surgery patients without a prior history of cardiac arrhythmias to identify perioperative new-onset VT by using a continuous electrocardiograph (ECG) device; the ECG monitoring period was started one day prior to surgery and continued up to two days afterwards. Preoperative cardiac risk factors, left ventricular function, medical therapy, and perioperative ischemia were noted.

The researchers found that new-onset perioperative VT was detected in 33 (7%) of the patients; the patients with perioperative VT had a significantly reduced left ventricular function, and were undertreated with statins. The VT patients also had an increased incidence of myocardial ischemia (30%) compared to patients without VT (18%). During a median follow-up of two years, cardiac death occurred in 56 patients, 48 of which were classified as sudden death; of all patients with perioperative VT, seven (21%) died due to sudden cardiac death within three years of vascular surgery. The researchers therefore suggest that cardiac high-risk patients with new-onset perioperative VT might benefit from preemptive ICD implantation, in addition to optimal focused medical therapy. The study was presented at the 64th Vascular Annual Meeting of the Society for Vascular Surgery (SVS), held during June 2010 in Boston (MA, USA).

"After adjusting for risk factors, new-onset perioperative VT was associated with sudden cardiac death,” said study presenter Tamara Winkel, M.D., and colleagues of the vascular surgery department. "Longer continuous implanted cardiac monitors could detect these perioperative episodes of arrhythmia, which in turn could have important therapeutic and prognostic consequences. In theory preemptive ICD implantation would benefit high-risk surgery patients and it is now important that more research be done in the future to support that.”

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