RESUMO
ABSTRACT Introduction: Classic coronary artery bypass grafting (CABG) surgery involves diastolic cardiac arrest under cardiopulmonary bypass, while off-pump CABG (OPCABG) has become widespread in recent years. Methods: 174 patients who underwent OPCABG were included in the study. Patients were divided into two groups. Group I (n=90) received ivabradine and Group M (n=84) received metoprolol before surgery until postoperative day 10. Intraoperative arrhythmias and hypotension were recorded. Postoperative atrial fibrillation (AF) and arrhythmia, mortality and morbidity rates were assessed based on the 30-day postoperative follow-up. Results: There were no significant differences in the intraoperative amount of inotropic support and red blood cell transfusion between groups (P=0.87 and P=0.31). However, the rates of intraoperative arrhythmias and hypotension were not significantly higher in Group M (P=0.317 and P=0.47). Ventricular tachycardia/ventricular fibrillation (VT/VF) was observed in 2 patients in both groups. Postoperative AF occurred in 7 patients (7.7%) in Group I and in 10 patients (11.9%) in Group M. Although there was a trend towards a higher prevalence of AF in Group M patients, this did not reach statistical significance. In addition, mortality and morbidity rates were comparable between groups.
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Abstract Inappropriate therapy due to noise oversensing caused a true ventricular fibrillation (VF) and a life-threatening event in a patient. A 19-year-old patient with surgically corrected congenital heart disease and systolic dysfunction had an implantable cardioverter defibrillator implanted for primary prevention in 2013. This patient was admitted at the Emergency Department in June 2018 after receiving eight shocks from the device on the same day, with a prolonged syncope after the third shock. Another noise-induced VF detection occurred, and two inappropriate shocks followed sequentially, causing true VF. Four appropriate shocks were subsequently needed until sinus rhythm was finally restored.
Assuntos
Humanos , Desfibriladores Implantáveis , Arritmias Cardíacas , Cardioversão ElétricaRESUMO
Cardioplegic myocardial protection has become the most popular method for coronary artery bypass surgery. In contrast, we reported 17 consecutive coronary artery bypass operations with ventricular fibrilation, nitroglycerine infusion, and moderate hypothermia. The average patients age was 55 years. 11 patients had stable angina, 4 patients unstable angina, 2 patients varient angina, and 6 patients had prior myocardial infarcation. On cardiac catheterization, the mean LVEDP was 17.32+/-2.13mmHg, EF was 0.67, and abnormal LV wall motion was noted in 5 patients. Premedication usually consisted of hydroxyzine 1~3mg/kg with or without morphine 0.05~0.1mg/kg IM. Induction agents was morphine sulfate, diazepam, lidocaine and pancuronium for muscle relaxant. Maintaninance agents were nitrous oxide, morphine with small dose of halothane or enflurane. Almost all case (15 patient) was infused nitroglycerine 0.5~1.5 microg/kg throughout entire procedure. After bypass, average patient's temperature maintained 25~28 degrees C, and ventricular fibrillation were induced with or without cold saline irrigation around the heart. Average mean arterial pressure were maintained 60~80 mmHg during bypass period. At the end of bypass, if spontaneous beating were not occurred under normal temperature, defibrillation were used. After bypass stop, methylprednisolone were injected in 15 patients. Average anesthetic time was 585 min., surgery time was 529 min, bypass time was 237 min. Arterial blood gas and electrolyte was acceptable range during all period. Complication implicated with anesthesia was myocardial infarction (3 patient), arrhythmia and transient vocal cord paralysis, 1 patient, respectively and no mortality. In all cases the anginal pain was improved.