Mahla E, Rotman B, Rehak P, Atlee J L, Gombotz H, Berger J, List W F, Klein W, Metzler H
Department of Anesthesiology, University of Graz, Austria.
Anesth Analg. 1998 Jan;86(1):16-21. doi: 10.1097/00000539-199801000-00004.
Noncardiac surgical patients with preoperative ventricular dysrhythmias and structural heart disease may be at increased risk of adverse cardiac outcome. We evaluated how anesthesia and surgery affect the course of ventricular dysrhythmias (premature ventricular beats [PVB] and repetitive forms of ventricular beats [RFVB]: couplets and nonsustained ventricular tachycardia) noted preoperatively in patients with structural heart disease and whether the frequency of ventricular dysrhythmias affects cardiac outcome. In a prospective study, 70 patients scheduled for noncardiac surgery with structural heart disease and RFVB on preoperative Holter electrocardiogram were continuously monitored intraoperatively and for 3 days postoperatively. Holter tracings were analyzed for rhythm, medians of total PVB and RFVB per hour. Preoperative RFVB recurred intraoperatively in 35% and postoperatively in 87% of patients. There was a significant intra- and postoperative decrease of total PVB per hour (P < 0.05) and RFVB per hour (P < 0.01). Frequency of ventricular dysrhythmias in the five patients suffering adverse outcome (unstable angina, n = 1; congestive heart failure, n = 4) did not significantly differ from those with good outcome. We conclude that in noncardiac surgical patients with structural heart disease and RFVB, the frequency of ventricular dysrhythmias is not associated with adverse cardiac outcome.
Using continuous electrocardiogram monitoring, we investigated whether the frequency of perioperative ventricular dysrhythmias independently affects outcome in patients with structural heart disease undergoing noncardiac surgery. The incidence of perioperative dysrhythmia in patients with an adverse outcome (8%) did not differ from those with a good outcome.
术前存在室性心律失常且有结构性心脏病的非心脏手术患者发生不良心脏结局的风险可能会增加。我们评估了麻醉和手术如何影响术前在结构性心脏病患者中记录到的室性心律失常（室性早搏[PVB]和室性心动过速的重复性形式[RFVB]：成对室早和非持续性室性心动过速）的病程，以及室性心律失常的频率是否会影响心脏结局。在一项前瞻性研究中，对70例计划进行非心脏手术且术前动态心电图显示有结构性心脏病和RFVB的患者在术中及术后3天进行持续监测。分析动态心电图记录的心律、每小时总PVB和RFVB的中位数。术前RFVB在35%的患者术中复发，87%的患者术后复发。每小时总PVB（P<0.05）和每小时RFVB（P<0.01）在术中和术后均显著下降。5例出现不良结局（不稳定型心绞痛，n=1；充血性心力衰竭，n=4）的患者的室性心律失常频率与结局良好的患者相比无显著差异。我们得出结论，在患有结构性心脏病和RFVB的非心脏手术患者中，室性心律失常的频率与不良心脏结局无关。
我们通过持续心电图监测，研究了围手术期室性心律失常的频率是否独立影响接受非心脏手术的结构性心脏病患者的结局。不良结局患者的围手术期心律失常发生率（8%）与结局良好的患者无差异。
