Atrial Fibrillation
Read Time: 2 mins

57/Incidence of ventricular tachycardia after surgical aortic valve replacement

Copy Link
Published Online: Oct 3rd 2011 European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr57
Authors: Rok Mravljak (Presenting Author) - Barts Health NHS Trust, London; P Waddingham - Barts Health NHS Trust, London; C Monkhouse - Barts Health NHS Trust, London; J Elliott - Barts Health NHS Trust, London; S Mohanakumar - Barts Health NHS Trust, London; J Malcolmson - Barts Health NHS Trust, London; S Jones - Barts Health NHS Trust, London; M Orini - Barts Health NHS Trust, London; J Bennett - Barts Health NHS Trust, London; M Earley - Barts Health NHS Trust, London; P Lambiase - Barts Health NHS Trust, London; GD Thornton - Barts Health NHS Trust, London; TA Treibel - Barts Health NHS Trust, London
Quick Links:
Article Information

Introduction: Surgical aortic valve replacement (SAVR) improves outcome in patients with severe aortic stenosis (AS). Nevertheless, late mortality remains high (between 15-35% at 3.5 years in some series) following SAVR. Whether this is related to heart failure or brady-/tachyarrhythmia is unknown, and the burden of ventricular arrhythmia after
SAVR remains poorly characterised.

Objectives: To determine the incidence of ventricular arrhythmia, post SAVR for severe AS in patients with implantable electronic devices.

Methods: 134 consecutive patients undergoing SAVR for severe AS between April 2015 and May 2018 who had a pacemaker or defibrillator implanted post-AVR were retrospectively reviewed. Exclusions were more than moderate other valve disease, history of cardiomyopathy (n=18) and follow up at different centre (n=47). The primary outcome was the incidence of ventricular tachycardia, defined as ≥5 consecutive beats of broad complex tachycardia. Device and mortality data were reviewed via patients’ electronic records.

Results: 69 out of 134 patients with a device implanted post AVR were included (age 67 ± 14 years, 52 [75%] males) with 19 (27.5%) having undergone AVR and concomitant CABG. Common comorbidities were arterial hypertension (n=52; 75%), diabetes mellitus (n=10; 15%) and chronic kidney disease (n=4; 6%) with only a minority of patients having significant LV impairment (n=3, 4%). Devices implanted were permanent pacemaker (PPM; 83%), cardiac resynchronization therapy device CRT-P (11%) and CRT-D (6%). Bradycardia indications for implantation were atrioventricular block (77%), and sinus node disease (23%). 52 (75%) patients were prescribed ≥1 antiarrhythmic medication (Bisoprolol, Metoprolol, Sotalol or Amiodarone) with 4 (6%) taking a combination of two antiarrhythmics (Bisoprolol + Amiodarone, Bisoprolol + Digoxin). Data showed high incidence of paroxysmal atrial fibrillation (AF) post-op (N=61; 88%) with 18 (26%) patients remaining in persistent AF. 39 (57%) patients had ventricular arrhythmia, of which 32 (46.4%) patients had NSVT (<30 RR intervals) and 7 (10%) had sustained VT. Median duration of ventricular arrhythmias was 17 RR intervals (IQR: 8-27). During a median follow-up duration of 2.75 years (IQR: 2-3) 9 patients (13%) died, one of post-op complications, one of acute cardiac arrhythmia and 7 unknown. Of those that died after 30 days, 4 (44%) had documented evidence of NSVT/VT.

Conclusion: Ventricular tachycardia (VT/NSVT) is common in patients after SAVR for severe AS. 44% of patients who died post discharge had evidence of ventricular arrhythmia detected by the implanted device. Further prospective studies are required to determine the aetiology of arrhythmias, the region of substrate and their association with poor outcomes.

Further Resources

Share this Article
Related Content In Atrial Fibrillation
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72