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Ann Thorac Surg 1992;53:642-647
© 1992 The Society of Thoracic Surgeons
IV Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
Accepted for publication September 17, 1991.
* Address reprint requests to Dr von Knorring, IV Department of Surgery, Helsinki University Central Hospital, Kasarmikatu 11–13, 00130 Helsinki, Finland.
The records of 598 patients undergoing a thoracic surgical procedure for lung cancer from 1975 through 1989 were reviewed for occurrence of cardiac arrhythmias and myocardial ischemic events. Atrial tachycardias occurred in 16% ( [equation]); atrial fibrillation was preponderant (87%), followed by supraventricular tachycardia and atrial flutter. Patients with recurrent episodes of dysrhythmias had a significantly higher mortality rate than those without episodes or with a single episode only (17% versus 2.4%; p < 0.01). Transient ischemic electrocardiographic changes were documented in 23 patients (3.8%) and myocardial infarction in 7 (1.2%). An abnormal preoperative exercise test result and intraoperative hypotension wen strongly associated with both dysrhythmia and ischemia (p < 0.01). Pneumonectomy, ischemic changes on the electrocardiogram, and cardiac enlargement were also associated with arrhythmias (p < 0.01). A weaker association (p < 0.05) was found between postoperative arrhythmias and old myocardial infarction (>6 months), arterial hypertension, and heart failure. Pulmonary function had no predictive value in this respect. A history of angina or old myocardial infarction was predictive of transient postoperative myocardial ischemia but not myocardial infarction. Despite improved anesthetic and monitoring techniques and more frequent use of the intensive care unit postoperatively in the last decade, the incidence of arrhythmias after thoracotomy has not decreased. More effective prevention is needed, particularly for patients with defined preoperative and perioperative risk factors.
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