Postoperative arrhythmias after coronary artery and cardiac valvular surgery detected by long-term electrocardiographic monitoring.
Postoperative arrhythmias after coronary artery and cardiac valvular surgery detected by long-term electrocardiographic monitoring.
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通过长期心电图监测发现冠状动脉和心脏瓣膜手术后的术后心律失常。
DOI：
10.1016/0002-8703(79)90390-9
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发表时间：
1979
影响因子：
4.8
通讯作者：
H. Macvaugh
中科院分区：
文献类型：
--
作者：
E. Michelson;E. Michelson;J. Morganroth;J. Morganroth;H. Macvaugh;H. Macvaugh
24小时长期心电图记录作为常规围手术期监测的补充，以确定冠状动脉搭桥术和心脏瓣膜置换术后心律失常发生的频率和意义。患者在手术前24小时以及从重症监护出院后的第1天和第5天接受“动态”心电图监测。50例患者中有26例（52%）在冠状动脉搭桥术后发生新的心律失常，15例患者中有6例（40%）在瓣膜置换术后发生新的心律失常。心律失常检测的高频率直接归因于长期心电图的使用。瓣膜搭桥手术和冠状动脉搭桥手术后新的心房心律失常都很常见（分别为44%和38%的患者）。两组患者术前室性心律失常均不常见，但冠状动脉搭桥术后发生率较高（36%）。在这个系列中，心律失常导致发病率，但不导致死亡率。这些结果表明，冠状动脉搭桥术或瓣膜手术后发生的新的心房心律失常可能更多地与手术的直接胸内后遗症有关，而不是与特定的潜在心脏病变有关，相反，室性心律失常可能对缺血患者更为特异性。长期心电图记录是围手术期心电图监测常规方法的补充。
Twenty-four hour long-term electrocardiographic recordings were used to supplement routine perioperative monitoring to determine the frequency and significance of arrhythmias occurring after coronary artery bypass graft surgery and cardiac valve replacement. Patients underwent “ambulatory” electrocardiographic monitoring for 24 hours before surgery and on the first and fifth days after discharge from intensive care.New arrhythmias occurred in 26 of 50 patients (52 per cent) after coronary artery bypass graft surgery and in six of 15 patients (40 per cent) after valve replacement. This high frequency of arrhythmia detection was directly attributable to the use of long-term electrocardiography. New atrial arrhythmias were common after both valvular and coronary artery bypass graft surgery (44 per cent and 38 per cent of patients, respectively). Ventricular arrhythmias were uncommon preoperatively in both groups but occurred frequently after coronary artery bypass graft surgery (36 per cent). Arrhythmias contributed to morbidity but not to mortality in this series.These results suggest that new atrial arrhythmias occurring after coronary artery bypass graft or valvular surgery may be related more to the immediate intrathoracic sequelae of surgery than to a specific underlying cardiac lesion, in contrast to ventricular arrhythmias which may be more specific for patients with ischemia. Long-term electrocardiographic recording is a useful technique to supplement routine methods of perioperative electrocardiographic monitoring.