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The Annals of Thoracic Surgery, Vol 53, 642-647, Copyright © 1992 by The Society of Thoracic Surgeons
J von Knorring, M Lepantalo, L Lindgren and O Lindfors
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% (94/598); 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
less than 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
were strongly associated with both dysrhythmia and ischemia (p less than
0.01). Pneumonectomy, ischemic changes on the electrocardiogram, and
cardiac enlargement were also associated with arrhythmias (p less than
0.01). A weaker association (p less than 0.05) was found between
postoperative arrhythmias and old myocardial infarction (greater than 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.
ARTICLES
Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer
IV Department of Surgery, Helsinki University Central Hospital, Finland.
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