Tam S K, Miller J M, Edmunds L H
Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia 19104.
J Thorac Cardiovasc Surg. 1991 Dec;102(6):883-9.
Unexpected, sustained ventricular tachyarrhythmia after cardiac operations is differentiated from sustained ventricular tachycardia and ventricular fibrillation from known antecedent causes, such as recent or perioperative myocardial infarction, low cardiac output, preoperative ventricular arrhythmia, sympathomimetic drugs, drug toxicity, and metabolic abnormalities. Sixteen of 2364 patients (0.68%) who underwent heart operations met strict exclusion criteria for unexpected sustained ventricular tachyarrhythmia that occurred 1 hour to 12 days after operation. Recurrent ventricular tachyarrhythmias occurred in 12 patients; three died (21%), despite resuscitation from the initial episode. All patients had significant preoperative left ventricular dysfunction and 14 had ejection fractions below 30%. Fifteen of the 16 patients had monomorphic ventricular tachycardia at the initial episode. Empirically prescribed therapy was not effective in suppressing ventricular tachyarrhythmias inducible by programmed stimulation during postevent electrophysiologic studies in 10 of the 13 survivors. Inducibility was eventually prevented by drugs in nine patients, three patients received automatic implantable cardiac defibrillators, and one patient underwent successful catheter ablation of ventricular tachycardia. No patient died of recurrent ventricular tachyarrhythmias during the follow-up of 8 to 55 (mean 29) months after hospital discharge.
心脏手术后出现的意外持续性室性心律失常，与已知先前病因（如近期或围手术期心肌梗死、低心输出量、术前室性心律失常、拟交感神经药物、药物毒性和代谢异常）导致的持续性室性心动过速和心室颤动有所不同。在2364例接受心脏手术的患者中，有16例（0.68%）符合术后1小时至12天出现意外持续性室性心律失常的严格排除标准。12例患者出现复发性室性心律失常；尽管对首次发作进行了复苏，但仍有3例死亡（21%）。所有患者术前均有明显的左心室功能障碍，14例患者的射血分数低于30%。16例患者中有15例在首次发作时为单形性室性心动过速。在13例幸存者的事件后电生理研究中，经验性规定的治疗对抑制程序刺激诱发的室性心律失常无效。最终，9例患者通过药物预防了可诱导性，3例患者接受了植入式自动心脏除颤器，1例患者成功进行了室性心动过速的导管消融。出院后8至55个月（平均29个月）的随访期间，无患者死于复发性室性心律失常。
