Author + information
- Received June 16, 1989
- Revision received September 6, 1989
- Accepted September 21, 1989
- Published online February 1, 1990.
- Patricia Kelly, MD1,3,
- Jeremy N. Ruskin, MD, FACC1,
- Gus J. Vlahakes, MD1,
- Mortimer J. Buckley Jr., MD, FACC1,
- Charles S. Freeman, RN1 and
- Hasan Garan, MD, FACC*,1,2
- ↵*Address for reprints:Hasan Garan, MD, Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
In a selected subgroup of 50 survivors of cardiac arrest, the impact of surgical myocardial revascularization on inducible arrhythmias, arrhythmia recurrence and long-term survival was examined. The effects of several clinical, angiographic and electrophysiologic variables on arrhythmia recurrence and survival were also analyzed. All patients had a prehospital cardiac arrest and severe operable coronary artery disease and underwent myocardial revascularization.
Preoperative electrophysiologic study was performed in 41 patients; 33 (80%) had inducible ventricular arrhythmias. Of 42 patients studied off antiarrhythmic drugs postoperatively, 19 (45%) had inducible ventricular arrhythmias. Thirty patients with inducible arrhythmias preoperatively underwent postoperative testing off antiarrhythmic drugs; arrhythmia induction was suppressed in 14 (47%). By multivariate analysis, the induction of ventricular fibrillation at the preoperative electrophysiologic study was the only significant predictor of induced ventricular arrhythmia suppression by coronary surgery (p < 0.001). Inducible ventricular fibrillation was not present postoperatively in any of the 11 patients who manifested this arrhythmia preoperatively. In contrast, inducible ventricular tachycardia persisted in 80% of patients in whom preoperative testing induced this arrhythmia.
Patients were followed up for 39 ± 29 months. There were four arrhythmia recurrences; one was fatal. There were three nonsudden cardiac deaths and three noncardiac deaths. By life-table analysis, 5 year survival, cardiac survival and arrhythmia-free survival rates were 88%, 98%, and 88%, respectively. Depressed left ventricular ejection fraction and advanced age were predictive of death (p = 0.015 and 0.026, respectively) and cardiac death (p = 0.037 and 0.05, respectively).
In conclusion, in a selected subgroup of survivors of cardiac arrest, coronary revascularization abolished inducible arrhythmias in a substantial proportion, especially when the induced arrhythmia was ventricular fibrillation. Long-term prognosis in these patients is excellent.
- Received June 16, 1989.
- Revision received September 6, 1989.
- Accepted September 21, 1989.
- American College of Cardiology Foundation