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  • Title: Long-term management of bradyarrhythmias following open heart surgery: surgical A-V block and sick sinus syndrome after surgery for secundum atrial septal defects treated with permanent cardiac pacing.
    Author: Ohnishi S, Kasanuki H, Takamizawa K, Takao A, Hirosawa K.
    Journal: Jpn Circ J; 1986 Sep; 50(9):903-17. PubMed ID: 3099026.
    Abstract:
    Postoperative clinical findings from 25 patients with surgical A-V block and 12 with SSS following surgery for ASD who received permanent pacemakers were analyzed in order to consider the long-term management of postoperative bradyarrhythmias. Surgical A-V block: Episodes of Adams-Stokes were observed in 11/25 patients before pacemaker implantation, and in 6 of these (55%) the onset of episodes occurred more than a year after open heart surgery. Of 8 cases for which ECG's during Adams-Stokes were available, 2 had bifascicular or trifascicular block which progressed to complete A-V block below the His bundle. The 6 others (75%) had ventricular tachycardia or ventricular flutter-fibrillation during Adams-Stokes. 2 of these had blocks above the His bundle. 4/25 had improvement of complete A-V block within a month. Following pacemaker implantation, 3 died of heart failure and 3 of sudden death. 5 year survival was 70%. Therefore, surgical A-V block requires careful long-term management, and the presence of ventricular tachyarrhythmias as well as the location of block are important predictors of patient risk. SSS after surgery for ASD: 10/12 patients had Adams-Stokes, of which 6 (60%) had initial onset over 5 years after surgery, and 9 had paroxysmal atrial flutter and fibrillation which coincided with the onset of Adams-Stokes. 3 of 7 patients (42%) for whom preoperative ECG's were available had sinus bradycardia. Thus, SSS after ASD surgery may be preceded by preoperative deterioration of sinus node function and succeeded by late onset of Adams-Stokes, necessitating pre- and postoperative assessment of sinus node function. The presence of atrial tachyarrhythmias also serves as an important indicator of the severity of SSS after ASD surgery. The onset of Adams-Stokes varied by patient over a wide range of time, emphasizing the need for careful long-term follow-up. Clinical symptoms and prognosis were affected by tachyarrhythmias as well as the severity of the bradycardia. Therefore, the presence of ventricular/atrial tachyarrhythmias is an important factor in the long-term management of postoperative bradyarrhythmias.
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