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Arrhythmias in Patients after Surgical Myocardial Revascularization

https://doi.org/10.20996/1819-6446-2020-02-19

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Abstract

This work represents literature review data regarding the study of the effect of surgical myocardial revascularization on the processes of electrical myocardial instability underlying the onset of life-threatening ventricular arrhythmias, as well as the possibilities for its non-invasive assessment by studying the heart rhythm variability and turbulence. Analyzed data demonstrated that, relying only on the presence of a viable myocardium, it is often impossible to predict the positive effect of revascularization on the prognosis in patients, especially those with reduced myocardial contractility. Considering the well-studied relationship between myocardial remodeling and neurohormonal activation, such non-invasive methods for assessing vegetative regulation of cardiac activity, as heart rate variability and turbulence may provide additional diagnostic information. The literature data indicate that heart failure, ventricular arrhythmias and recurrences of angina and myocardial infarction are the main problems that determine an unfavorable outcome in the postoperative period. There is important evidence that violations of the vegetative regulation of the heart, the heterogeneity of repolarization processes in the myocardium are integral indicators of the morphofunctional changes occurring in the process of coronary heart disease (CHD) progression. The role of indicators of heart rate variability and turbulence as predictors of sudden cardiac death was proved, mainly due to fatal ventricular heart rhythm disorders and cardiovascular mortality. Along with this, changes in these indicators, and their prognostic role in patients with CHD in revascularization are the subject of discussion, which determines the relevance of further studies on the effect of various methods of revascularization on the electrical instability of the myocardium, as one of the most important factors in the development of life-threatening ventricular arrhythmias that are predictors of sudden cardiac death, especially in patients who previously had acute myocardial infarction. Besides it is important to study the effect of myocardial revascularization on the indicators of cardiac autonomic regulation and the possibility of their use as prognostic criteria before and after surgery.

About the Authors

N. U. Zakirov
Republican Specialized Scientific and Practical Medical Center of Cardiology
Uzbekistan

Nodir U. Zakirov – MD, PhD, Chief Researcher, Cardiac Arrhythmias Department

Osiyo ul. 4, Tashkent, 100052



A. G. Kevorkov
Republican Specialized Scientific and Practical Medical Center of Cardiology
Uzbekistan

Amayak G. Kevorkov – MD, PhD, Senior Researcher, Cardiac Arrhythmias Department

Osiyo ul. 4, Tashkent, 100052



A. S. Rasulov
Republican Specialized Scientific and Practical Medical Center of Cardiology
Uzbekistan

Alisher S. Rasulov – Junior Researcher, Cardiac Arrhythmias Department

Osiyo ul. 4, Tashkent, 100052



E. Y. Tursunov
Republican Specialized Scientific and Practical Medical Center of Cardiology
Uzbekistan

Ergashali Y. Tursunov – Junior Researcher, Cardiac Arrhythmias Department

Osiyo ul. 4, Tashkent, 100052



References

1. Carson P., Wertheimer J., Miller A., et al.; STICH Investigators. The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results. JACC Heart Fail. 2013;1(5):400-8. DOI:10.1016/j.jchf.2013.04.012.

2. Veenhuyzen G.D., Singh S.N., McAreavey D., et al. Prior coronary artery bypass surgery and risk of death among patients with ischemic left ventricular dysfunction. Circulation. 2001;104(13):148993. DOI:10.1161/hc3801.096335.

3. Kolh P., Kurlansky P., Cremer J., et al. Transatlantic Editorial: A Comparison between European and North American Guidelines on Myocardial Revascularization. Ann Thorac Surg. 2016;101(6):203144. DOI:10.1016/j.athoracsur.2016.02.062.

4. Booth J., Clayton T., Pepper J., et al.; SoS Investigators. Randomized, controlled trial of coronary artery bypass surgery versus percutaneous coronary intervention in patients with multivessel coronary artery disease: six-year follow-up from the Stent or Surgery Trial (SoS). Circulation. 2008;118(4):381-8. DOI:10.1161/CIRCULATIONAHA.107.739144.

5. Farkouh M.E., Domanski M., Sleeper L.A., et al.; FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367(25):2375-84. DOI:10.1056/NEJMoa1211585

6. Park S.J., Ahn J.M., Kim Y.H., et al.; BEST Trial Investigators. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med. 2015;372(13):1204-12. DOI:10.1056/NEJMoa1415447.

7. Rodriguez A.E., Baldi J., Fernández Pereira C., et al.; ERACI II Investigators. Five-year follow-up of the Argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). J Am Coll Cardiol. 2005 Aug 16;46(4):582-8. DOI:10.1016/j.jacc.2004.12.081.

8. Serruys P.W., Morice M.C., Kappetein A.P., et al.; SYNTAX Investigators. Percutaneous coronary intervention versus coronary artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360(10):961-72. DOI:10.1056/NEJMoa0804626.

9. Serruys P.W., Ong A.T., van Herwerden L.A., et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J Am Coll Cardiol. 2005;46(4):575-81. DOI:10.1016/j.jacc.2004.12.082.

10. Serruys P.W., Onuma Y., Garg S., et al.; ARTS II Investigators.5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J Am Coll Cardiol. 2010;55(11):1093-101. DOI:10.1016/j.jacc.2009.11.049.

11. Cascio W.E., Yang H., Muller-Borer B.J., Johnson TA. Ischemia-induced arrhythmia: the role of connexins, gap junctions, and attendant changes in impulse propagation. J Electrocardiol. 2005;38(4Suppl):55-9. DOI:10.1016/j.jelectrocard.2005.06.019.

12. Belenkov Y.N., Akchurin R.S., Savchenko A.P., et al. Changes of autologous coronary vessels and aortocoronary grafts in patients with ischemic heart disease after coronary artery bypass grafting. Kardiologiia. 2002;42(12):29-34 (In Russ.)

13. Zhbanov I.V., Abugov S.A., Saakyan Y.M., et al. The state of coronary vascular bed during angina recurrence after coronary artery bypass surgery. Kardiologiia. 2000;9:4-11 (In Russ.)

14. Hartikainen J.E., Malik M., Staunton A., et al. Predictive Power of Heart Rate Variability Used as a Stratifier of Cardiac Mortality After Myocardial Infarction in Patients Discharged With and Without Beta‐Blocker Therapy. Annals of Noninvasive Electrocardiology. 1996;1:12-8. DOI:10.1111/j.1542474X.1996.tb00257.x.

15. Rjabykina G.V., Sobolev A.V. Heart rate variability. Moscow: Star K; 1998 (In Russ.) [Рябыкина Г.В., Соболев А.В. Вариабельность ритма сердца. М.: Стар К; 1998].

16. Sobolev A.V. Analysis of heart rate variability on long time intervals. Moscow: Medpraktika; 2009. (In Russ.)

17. Schmidt G., Malik M., Barthel P., et al. Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet. 1999;353(9162):1390-6. DOI:10.1016/S0140-6736(98)08428-1.

18. Bauer A., Barthel P., Schneider R., et al. Improved Stratification of Autonomic Regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-Risk). Eur Heart J. 2009;30(5):576-83. DOI:10.1093/eurheartj/ehn540.

19. Hohnloser S.H., Ikeda T., Cohen R.J. Evidence regarding clinical use of microvolt T-wave alternans. Heart Rhythm. 2009;6(3 Suppl):S36-44. DOI:10.1016/j.hrthm.2008.10.011.

20. Hoshida K., Miwa Y., Miyakoshi M., et al. Simultaneous assessment of T-wave alternans and heart rate turbulence on Holter electrocardiograms as predictors for serious cardiac events in patients after myocardial infarction. Circ J. 2013;77(2):432-8. DOI:10.1253/circj.cj-12-0789.

21. Golukhova E.Z., Gromova O.I., Merzlyakov V.Y., et al. Heart rate turbulence and brain natriuretic peptide level as predictors for life-threatening arrhythmias in patients with coronary artery disease. Kreativnaya Kardiologiya. 2013;2:62-77 (In Russ.)

22. Okisheva E.A., Tsaregorodtsev D.A., Sulimov V.A. Heart rate turbulence and microvolt T wave alternans in patients after myocardial infarction.Vestnik Aritmologii. 2010;62:26-31 (In Russ.)

23. Bayés de Luna A., Coumel P., Leclercq J.F. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J. 1989;117(1):151-9. DOI:10.1016/0002-8703(89)90670-4.

24. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol. 2006;48(5):e247-346. DOI:10.1016/j.jacc.2006.07.010.

25. Furukawa T., Moroe K., Mayrovitz H.N., et al. Arrhythmogenic effects of graded coronary blood flow reductions superimposed on prior myocardial infarction in dogs. Circulation. 1991;84(1):368-77. DOI:10.1161/01.cir.84.1.368.

26. Kimura S., Bassett A.L., Cameron J.S., et al. Cellular electrophysiological changes during ischemia in isolated, coronary-perfused cat ventricle with healed myocardial infarction. Circulation. 1988;78(2):401-6. DOI:10.1161/01.cir.78.2.401.

27. Rizzello V., Poldermans D., Boersma E., et al. Opposite patterns of left ventricular remodeling after coronary revascularization in patients with ischemic cardiomyopathy: role of myocardial viability. Circulation. 2004;110(16):2383-8. DOI:10.1161/01.CIR.0000145115.29952.14

28. Saidova M.A., Belenkov Y.N., Akchurin R.S., et al. Viable myocardium: comparative evaluation of surgical and pharmacological treatment of patients with ischemic heart disease, post-infarct cardiosclerosis and chronic cardiac failure. Ter Arkhiv. 2002;74(2):60-4 (In Russ.)

29. Schinkel A.F., Poldermans D., Rizzello V., et al. Why do patients with ischemic cardiomyopathy and a substantial amount of viable myocardium not always recover in function after revascularization? J Thorac Cardiovasc Surg. 2004;127(2):385-90. DOI:10.1016/j.jtcvs.2003.08.005.

30. Bonow R.O., Maurer G., Lee K.L., et al.; STICH Trial Investigators. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med. 2011;364(17):1617-25. DOI:10.1056/NEJMoa1100358.

31. Belenkov Y.N., Mareev V.Y., Ageev F.T. Chronic heart failure: selected lectures on cardiology. Moscow: Geotar-Media; 2006. (In Russ.)

32. Kliks B.R., Burgess M.J., Abildskov J.A. Influence of sympathetic tone on ventricular fibrillation threshold during experimental coronary occlusion. Am J Cardiol. 1975;36(1):45-9. DOI:10.1016/00029149(75)90866-8.

33. Vanoli E., De Ferrari G.M., Stramba-Badiale M., Hull S.S. Jr, et al. Vagal stimulation and prevention of sudden death in conscious dogs with a healed myocardial infarction. Circ Res. 1991;68(5):147181. DOI:10.1161/01.res.68.5.1471.

34. Huikuri H.V., Valkama J.O., Airaksinen K.E., et al. Frequency domain measures of heart rate variability before the onset of nonsustained and sustained ventricular tachycardia in patients with coronary artery disease. Circulation. 1993;87(4):1220-8. DOI:10.1161/01.cir.87.4.1220.

35. Shusterman V., Aysin B., Gottipaty V., et al. Autonomic nervous system activity and the spontaneous initiation of ventricular tachycardia. ESVEM Investigators. Electrophysiologic Study versus Electrocardiographic Monitoring Trial. J Am Coll Cardiol. 1998;32(7):1891-9. DOI:10.1016/s07351097(98)00468-9.

36. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043-65.

37. Huikuri H.V., Stein P.K. Clinical application of heart rate variability after acute myocardial infarction. Front Physiol. 2012;3:41. DOI:10.3389/fphys.2012.00041.

38. National Russian guidelines on application of the methods of Holter monitoring in clinical practice. Russ J Cardiol. 2014;2(106):6-71 (In Russ.)

39. Pelliccia F., Gallo P., Cianfrocca C., et al. Relation of complex ventricular arrhythmias to presenting features and prognosis in dilated cardiomyopathy. Int J Cardiol. 1990;29(1):47-54.

40. Bigger J.T. Jr, Fleiss J.L., Steinman R.C., et al. Correlations among time and frequency domain measures of heart period variability two weeks after acute myocardial infarction. Am J Cardiol. 1992;69(9):891-8. DOI:10.1016/0002-9149(92)90788-z.

41. Kleiger R.E., Miller J.P., Bigger J.T. Jr, Moss A.J. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59(4):256-62. DOI:10.1016/0002-9149(87)90795-8.

42. Tsuji H., Larson M.G., Venditti F.J. Jr, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 1996;94(11):2850-5. DOI:10.1161/01.cir.94.11.2850.

43. La Rovere M.T., Bigger J.T. Jr, Marcus F.I., et al. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes after Myocardial Infarction) Investigators. Lancet 1998;351(9101):478-84. DOI:10.1016/s01406736(97)11144-8

44. Lakusic N., Mahovic D., Sonicki Z., et al. Outcome of patients with normal and decreased heart rate variability after coronary artery bypass grafting surgery. Int J Cardiol. 2013;166(2):516-8. DOI:10.1016/j.ijcard.2012.04.040.

45. Bauer A., Malik M., Schmidt G., et al. Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol 2008;52(17):1353-65. DOI:10.1016/j.jacc.2008.07.041

46. Barthel P., Schneider R., Bauer A., et al. Risk stratification after acute myocardial infarction by heart rate turbulence. Circulation 2003;108(10):1221-6. DOI:10.1161/01.CIR.0000088783.34082.89.

47. Mäkikallio T.H., Barthel P., Schneider R., et al. Prediction of sudden cardiac death after acute myocardial infarction: role of Holter monitoring in the modern treatment era. Eur Heart J 2005;26(8):7629. DOI:10.1093/eurheartj/ehi188.

48. Huikuri H.V., Stein P.K. Heart rate variability in risk stratification of cardiac patients. ProgCardiovasc Dis. 2013;56(2):153-9. DOI:10.1016/j.pcad.2013.07.003.

49. Cygankiewicz I., Zareba W., Vazquez R., et al. Relation of heart rate turbulence to severity of heart failure. Am J Cardiol. 2006;98(12):1635-40. DOI:10.1016/j.amjcard.2006.07.042.

50. Huikuri H.V., Raatikainen M.J., Moerch-Joergensen R., et al.; Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction study group. Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction. Eur Heart J. 2009;30(6):689-98. DOI:10.1093/eurheartj/ehn537.

51. Cygankiewicz I., Wranicz J.K., Bolinska H., et al. Prognostic significance of heart rate turbulence in patients undergoing coronary artery bypass grafting. Am J Cardiol. 2003;91(12):1471-4. DOI:10.1016/s0002-9149(03)00402-8.

52. Cygankiewicz I., Wranicz J.K., Bolinska H., et al. Influence of coronary artery bypass grafting on heart rate turbulence parameters. Am J Cardiol. 2004;94(2):186-9. DOI:10.1016/j.amjcard.2004.03.059.

53. Soares P.P., Moreno A.M., Cravo S.L., Nóbrega A.C. Coronary artery bypass surgery and longitudinal evaluation of the autonomic cardiovascular function. Crit Care. 2005;9(2):R124-31. DOI:10.1186/cc3042.


For citation:


Zakirov N.U., Kevorkov A.G., Rasulov A.S., Tursunov E.Y. Arrhythmias in Patients after Surgical Myocardial Revascularization. Rational Pharmacotherapy in Cardiology. 2020;16(1):133-138. (In Russ.) https://doi.org/10.20996/1819-6446-2020-02-19

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ISSN 1819-6446 (Print)
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