TY - JOUR
T1 - Early and late post-operative arrhythmias after surgical myectomy
T2 - 45 years of follow-up
AU - Kharbanda, Rohit K.
AU - Lodder, Lucas
AU - Ragab, Ahmed A.Y.
AU - de Jong, Peter L.
AU - Kik, Charles
AU - Brundel, Bianca J.J.M.
AU - Taverne, Yannick J.H.J.
AU - de Groot, Natasja M.S.
AU - Bogers, Ad J.J.C.
N1 - Publisher Copyright: © 2020 The Author(s)
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Aims: The aims of this study are to investigate the incidence and determinants of post-operative atrial arrhythmias, conduction disorders and mortality in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing transaortic myectomy. Methods and results: This retrospective single-center study was conducted in 249 patients (median age 54 years [40–64], 42% female) undergoing transaortic myectomy. Post-operative atrial fibrillation (AF) was reported in 84 patients (33.7%), including 56 patients (22.5%) with de novo AF. Older age (HR = 1.027 (1.003–1.052), p = 0.029) and hypercholesterolemia (HR = 2.296 (1.091–4.832) p = 0.029) were independent predictors for de novo post-operative AF. Late post-operative AF and atrial flutter (AFL) occurred in 18.9% and 6.8% of the patients, respectively. De novo early post-operative AF increased the risk of late post-operative AF (HR = 3.138 (1.450–6.789), p = 0.004). Patients with a right bundle branch block had a higher risk of early-postoperative pacemaker implantation (p = 0.003, HR = 9.771 (2.195–43.505)). Higher age at time of surgery (HR = 1.053 (1.026–1.081), p < 0.001) was a predictor for late mortality (n = 47, 18.9%). Conclusion: Early and late post-operative AF, AFL and other SVTs are common sequelae after myectomy and are associated with older age at surgery, history of AF and early post-operative AF. Early post-operative arrhythmias are not transient and periodic rhythm monitoring is therefore essential to initiate therapy as soon as possible.
AB - Aims: The aims of this study are to investigate the incidence and determinants of post-operative atrial arrhythmias, conduction disorders and mortality in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing transaortic myectomy. Methods and results: This retrospective single-center study was conducted in 249 patients (median age 54 years [40–64], 42% female) undergoing transaortic myectomy. Post-operative atrial fibrillation (AF) was reported in 84 patients (33.7%), including 56 patients (22.5%) with de novo AF. Older age (HR = 1.027 (1.003–1.052), p = 0.029) and hypercholesterolemia (HR = 2.296 (1.091–4.832) p = 0.029) were independent predictors for de novo post-operative AF. Late post-operative AF and atrial flutter (AFL) occurred in 18.9% and 6.8% of the patients, respectively. De novo early post-operative AF increased the risk of late post-operative AF (HR = 3.138 (1.450–6.789), p = 0.004). Patients with a right bundle branch block had a higher risk of early-postoperative pacemaker implantation (p = 0.003, HR = 9.771 (2.195–43.505)). Higher age at time of surgery (HR = 1.053 (1.026–1.081), p < 0.001) was a predictor for late mortality (n = 47, 18.9%). Conclusion: Early and late post-operative AF, AFL and other SVTs are common sequelae after myectomy and are associated with older age at surgery, history of AF and early post-operative AF. Early post-operative arrhythmias are not transient and periodic rhythm monitoring is therefore essential to initiate therapy as soon as possible.
KW - Hypertrophic obstructive cardiomyopathy
KW - Myectomy
KW - Post-operative arrhythmias
UR - http://www.scopus.com/inward/record.url?scp=85097802993&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijcard.2020.11.055
DO - https://doi.org/10.1016/j.ijcard.2020.11.055
M3 - Article
C2 - 33271205
SN - 0167-5273
VL - 328
SP - 63
EP - 68
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -