Atrioventricular Conduction Disorders after Cardiac Surgery

Document Type : Research Paper

Authors

1 Assistant Professor of cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Assistant Professor of cardiology, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Associate professor ofAnesthesia,Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction
Atrioventricular conduction disorders are the most important common problems after cardiac surgeries, which may need pacemaker implantation. This may increase morbidity, mortality and hospital stayment. We studied the AV conductive disorders and their risk factors in patients who underwent cardiac surgery for different reasons.
Materials and Methods
A total of 400 cases that underwent cardiac surgery at Emam Reza hospital during the first half of 2006 were evaluated for time of onset and duration of AV block after surgery and need for pacemaker implantation during hospitalization.
Results
43%t of cases was female and 53% were male. CABG, VSD, ASD and PDA closure surgery were the most common procedures.38% had congenital heart diseases and 62% had acquired heart diseases. Permanent Pacemaker was needed in 1.3%. First degree AV block was the most common type (17.8%). Complete AV block was observed in all patients who underwent surgery for AV canal repairment. Occurrence of AV blocks was less common after CABG, but more frequent following surgery for congenital heart diseases. AV blocks, prolonged hospital stayment and need for permanent pacemaker. Multi-vessel coronary artery disease especially with RCA involvement, low EF and digoxin accompanied with increased risk of AV block.
Conclusion
Complete AV block is an important, but rare complication of cardiac surgery. This complication occurs more frequently after surgery for congenital heart disease that may need permanent pacemaker, prolonged hospital stayment and has increased morbidity.

Keywords


1-Antman EM, Braunwald E. Coronary circulation. A text book of cardiovascular medicine. 6th ed. Philadelphia:WB
saunders; 2001.vol 2. P.1146-1151.
2-Tinseley R, Braunwald E, Fauci A, Casper D, Hauser S, Longo D, et al. Cardiac arrhythmia, Harrisson principles of
internal medicine. 15th ed. Newyork: McGraw Hill; 2001.479-480.
3-Benetti FJ, Naselli G. Direct myocardial revascularization without extracorporal circulation. Experience in 700
patients. Chest 1991; 100:312-316.
4-Blackstone E, Jonas R, Kouchoukos N. Postoperative care.In: Kirklin JW. Cardiac surgery.3rd ed. Newyork:Churchill
livingstone; 2003.205-209.
5-Benetti FJ, Ballester C. Use of thoracoscopy and a minimal thoracotmy in mammary-coronary bypass to left anterior
descending artery without extracorporal circulation. Cardiovasc Surg 1995;10:529-536.
6- Puskas JD, Wright CE, Ronson RS, Brown WM, Gott JP, Guyton RA. Off-pump multivessel coronary bypass via
sternotomy is safe effective. Ann Thorac Surg 1998; 66:1068-1071.
7-Dewby M, Micheal J. Myocardial revascularization without cardiopulmonary bypass. In: Edmonds H. Cardiac
surgery. 2th. ed. New York: McGraw Hill; 2003.p.609-625.
8-Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cadiac surgery. Ann Intern Med 2001; 135:1061-1073.
9-Mina KC, Craig A, David Y. Arrythmia after cardiac and non-cardiac surgery. Cardiac arrhythmia.2th. ed.
Philadelphia: McGraw Hill; 2001.p.854-857.
10- Spotnitz HM. Pacemaker and automatic defibrillators. In: Edmonds H. Cardiac surgery in the adult. New
York:McGraw Hill; 200.p.1293-1326.
11- Smerup M, Hjortholm T, Johnsen SP, Pedersen AK, Hansen PS, Mortensen PT, et al. Pacemaker implantation after
congenital heart surgery: Risk and prognosis in a population-based follow-up study. Eur J Cardiothorac Surg 2005;
28:61-68.
12- Bruckheimer E, Berul CI, Kopf GS, Hill SL, Warner KA, Kleinman CS, et al. Late recovery of surgically induced
AV block patients with congenital heart surgery. J Interv Card Electrphysiol 2002; 6:191-195.
13- Ashida Y, Ohgi S, Kuroda H, Ishiguro S, Hamasaki T, Miyasaka S, et al. Permanent cardiac pacing following
surgery for acquired valvular disease . Ann Thorac Cardiovasc Surg 2000; 6:161-166.
14- Celiker A, Ozkutlu S, Karakurt C, Karagöz T.Cardiac dysrrythmia after transcatheter closure of ASD with
amplatzer device. Turk J Pediatr 2005; 47:323-326.
15- Gordon RS, Ivanov J, Cohen G, Ralph-Edwards AL. Permanent cardiac pacing after cardiac operation: predicting
the use of permanent pacemakers. Ann Thrac Surg 1998; 66:1698-1704.