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The Annals of Thoracic Surgery, Vol 36, 314-319, Copyright © 1983 by The Society of Thoracic Surgeons
CI Tchervenkov, JE Wynands, JF Symes, ID Malcolm, AR Dobell and JE Morin
The electrical activity of the heart was studied in 25 patients undergoing
elective coronary artery bypass grafting. Simultaneous surface
electrocardiograms and bipolar atrial electrograms were monitored
continuously from the onset of cardioplegic arrest until normal sinus
rhythm was reestablished. Several observations were made. (1)
Administration of cardioplegia promptly induced and maintained ventricular
arrest in all patients. (2) Atrial activity was seen in 23 patients during
global ischemia. (3) Following unclamping, the first sustained rhythm was
atrial in 22 patients and was associated initially with high-grade
atrioventricular block progressing to 1:1 conduction after a mean
reperfusion time of 23 minutes. (4) The time required for complete
electrical recovery varied directly with the cross-clamp time and the
amount of cardioplegic solution used. (5) Only 3 patients required
ventricular defibrillation. (6) In the postoperative period,
supraventricular tachyarrhythmias developed in 6 patients. Their occurrence
appeared to be related to prolonged atrial activity during the cross-clamp
period. Although cardioplegia administration maintained ventricular arrest,
sustained atrial activity often was present, perhaps implying inadequate
atrial protection and predisposing to atrial arrhythmias. Normal sinus
rhythm was reestablished spontaneously in all patients. The atrial
electrogram proved essential in the precise intraoperative recognition of
cardiac rhythm.
ARTICLES
Electrical behavior of the heart following high-potassium cardioplegia
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