Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Cardiac rhythm and conduction heart system disturbances in the early postoperative period in patients after the operation of arterial switch in different types of D-transposition of the great arteries

Authors: Isakova E.N., Kalinicheva Yu.B., Shvetsova E.A., Zaynetdinova E.K., Gornostaev A.A., Chernogrivov A.E., Bazylev V.V.

Company:
Federal Center of Cardiovascular Surgery, Ministry of Health of the RF, ul. Stasova, 6, Penza, 440071, Russian Federation

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Link: Clinical Physiology of Blood Circulaiton. 2014; (): -

Quote as: Isakova E.N., Kalinicheva Yu.B., Shvetsova E.A., Zaynetdinova E.K., Gornostaev A.A., Chernogrivov A.E., Bazylev V.V. Cardiac rhythm and conduction heart system disturbances in the early postoperative period in patients after the operation of arterial switch in different types of D-transposition of the great arteriesKlinicheskaya Fiziologiya Krovoobrashcheniya. 2014; 3: 34-42.

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Abstract

Objective – to investigate variability and predictors of cardiac rhythm and conduction heart system disturbances in the early postoperative period in patients after the operation of arterial switch in different types of D-transposition of the great arteries.
Material and methods. 103 patients with different forms of transposition of the great arteries were included in the study. Operation of arterial switch was made for the period from 2010 to 2014. 33 patients with arrhythmias after surgery were included in the first group. Mean age was 17.7 days (from 1 to 94 days), mean weight was 3.4 kg (from 2.5 to 5.6 kg). 70 patients without cardiac rhythm disturbances were included in the second group. Mean age was 10.6 days (from 1 to 79 days), mean weight was 3.5 kg (from 2.5 to 4.6 kg).
The following factors of cardiac arrhythmias development have been analyzed: age, body weight, diagnosis, infusion of vazaprostan and saturation level before the operation, the accompanying plastic ventricular septum defect and recon- struction of the aortic arch, the presence of coronary anomalies, the time of cardiopulmonary bypass and aortic cross- clamping, Aristotel Score, lactate level in the postoperative period, inotropic score and administration of levosimendan. Factors having significant differences between groups were evaluated by univariant logistic regression analysis.
Results. Total rate of cardiac rhythm disturbance was 32.0% (33 cases in 103 patients). The survival rate amounted to 91.3% (94 patients). The most common was ventricular premature contractions high degrees – 39.4% (13 cases), ventricular tachycardia was registered in 18.2% (6 cases) and atria-ventricular block III – in 18.2% (6 cases). Atrial tachy- cardia, atrial premature contractions, JET-tachycardia were registered in 6% cases. Ventricular fibrillation and atrial fib- rillation were developed in 3.0% (1 case) consequently. Predictors of cardiac rhythm disturbances in the early postoper- ative period were: mean arterial blood pressure before surgery (p=0.001, 95% CI [76,6–93,6], OR 0,847), plastic correction of ventricular septum defect (p=0.05 and 95% CI [95,8–101,4], OR 9,860), ejection fraction of the left ventri- cle after surgery (p=0.002, 95% CI [85,6–96,4], OR 0,908).
Conclusion. Total rate of cardiac rhythm disturbance after arterial switch was 32.0%. The most common was ventricular premature contractions high degrees – 39.4%. Predictors of cardiac rhythm disturbances in the early postoperative peri- od were: mean arterial blood pressure before surgery, plastic correction of ventricular septum defect, ejection fraction of the left ventricle after surgery.

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