- Email: [email protected]
OP-131 Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients?
MARCH 26e29, 2015 secondary prophylaxis, LVEF and serum creatinine well predicted the ES recurrence. Conclusion: Catheter ablation of ventricular arrhythmias in the course of ES in patients with ischemic cardiomyopathy is safe and effective, and probably improves their prognosis.
- OP-130 Development of Arrhythmogenic Cardiac Cardiomyopathy in Patients with Ventricular Extrasystoles. Ashot Hovhannesyan. Yerevan Cardiology Institute. Aim: To find scintigraphic criterions of beginning of arrhythmogenic cardiomyopathy in patients with ventricular extrasystoli (VE). Material-Methods: 63 patients with ventricular extrasystoles was included in the study. 29 mean, 34 wemen. Mean age 29 e 63 year. Inclusion criterions into study was registered ventricular extrasystoli by 12 lead ECG, >4000 es/24h on Holther monitoring. In 16 patient electrophysiological study (EP) following radiofrequency ablation (RF) was performed. In 21 patients coronaroangiography was performed, no evidence of ischemic heart disease (IHD) was found. We exclude all patients with evidence of organic heart diseases, atrial arrhythmias and QT segment changes. 12 patients with no evidence of arrhythmia formed control group. In all patients Echocardiography with tissue doppler and synchronized myocardial quantitative gated SPECT was performed using 99Tc-pyrophospate using AnyScan Multimodality Imaging System. In RF ablation group myocardial quantitative gated SPECT was performed also 3 monts after procedure. Results: Areas of local asynchronous contraction was seen in all patients. Asynchronous contraction zones was the same with ECG what confirmed by intracardiac ECG during EP study. Echocardiography with tissue Doppler was less sensitive. We observed 3 kind of disturbances: when patients have only right, left or VE’s originated from both ventricles. And also multifocal (2 and more foci) VE’s seen in LV localizations. All this sites was estimated as electrical and mechanical heterogenic sites. In 38 patients (60,3%) VE’s arising from RV outflow tract, VE’s source localization and preliminary contraction areas was RV anterior wall. LV VE’s, especially monofocal, was located in sinus of Valsalva and asyncronious zones located in the septum. In LV VE group moderate LV dilatation and reduced contraction was observed. Conclusion: Zones of asyncroni on the scintigraphic phase polarity maps in patients with VE could considered as sign of ectopy and beginning of arrhythmogenic cardiomyopathy.
Novel Parameters fort he Prediction of Atrial Fibrillation Development Saturday, March 28, 2015 17:00 PM w 18:30 PM, Hall 8 (Abstract nos. OP-131 w OP-137)
- OP-131
O R A L
Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients?. Pakize Kirdemir1, Vedat Yildirim2, Ilker Kiris3, Senol Gulmen4, Erkan Kuralay5, Erdogan Ibrisim6, Ertugrul Ozal7. 1Department of Anesthesiology, University of Suleyman Demirel, Isparta, Turkey; 2Department of Anesthesiology and Reanimation, Gulhane Military Academy of Medicine, Ankara, Turkey; 3Department of Cardiovascular Surgery, S¸ifa University, Izmir, Turkey; 4Department of Cardiovascular Surgery, University of Suleyman Demirel, Isparta, Turkey; 5Department of Cardiovascular Surgery, Lokman Hekim Hospital, Ankara, Turkey; 6Department of Cardiovascular Surgery, Anatolia Hospital, Antalya, Turkey; 7 Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey. Objective: To compare continuous insulin infusion (CII) and intermittent subcutaneous insulin therapy for preventing supraventricular tachycardia. The authors propose that continuous insulin therapy is more effective to reduce supraventricular tachycardias. Material: Two hundred diabetic patients were included in this prospective randomized study. Patients were divided into 2 groups according to their insulin therapy in 2 different centers. Group 1 included 100 diabetes mellitus (DM) patients, and CIIs were administrated. These patients received a CII infusion titrated per protocol in the perioperative period (Portland protocol). Group 2 also included 100 DM patients, and subcutaneous insulin was injected every 4 hours in a directed attempt to maintain blood glucose levels below 200 mg/dL. Sliding scale dosage of insulin was titrated to each patient’s glycemic response during the prior 4 hours. Results: There were 5 hospital mortalities in the intermittent insulin group. The causes of death were pump failure in 3 patients and ventricular fibrillation in 2 patients. There were 2 hospital mortalities in the CII group (p ¼ 0.044). Thirty-six patients in the intermittent insulin group and 21 patients in the CII group required positive inotropic drugs after cardiopulmonary bypass (p ¼ 0.028). Low cardiac output developed in 28 and 16 patients in the intermittent and CII groups, respectively (p ¼ 0.045). Univariate analysis identified positive inotropic drug requirement (p ¼ 0.011, odds ratio [OR] ¼ 3.41), ejection fraction (EF) (p ¼ 0.001, OR ¼ 0.92), cross-clamp time (p ¼ 0.046, OR ¼ 0.97), left internal mammary artery (p ¼ 0.023, OR ¼ 0.49), chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second <75% of predicted value (p ¼ 0.009, OR ¼ 2.02), intra-aortic balloon pump (p ¼ 0.045, OR ¼ 1.23), body mass index (p ¼ 0.035 OR ¼ 5.60), and CII (p < 0.001, OR ¼ 0.36) as predictors of SVT. Stepwise multivariate analysis confirmed the significance of some of the previously mentioned variables as predictors of SVT. The value of -2 log likelihood of multivariate analyses was 421.504. These were EF (p < 0.001, OR ¼ 0.91), positive inotropic drug requirement (p < 0.001, OR ¼ 3.94), COPD (p ¼ 0.036, OR ¼ 2.11), and CII (p < 0.001, OR ¼ 0.19). Conclusion: Continuous insulin therapy in the perioperative period reduces infectious complications, such as sternal wound infection and mediastinitis, cardiac mortality caused by pump failure, and the risk of development of supraventricular tachycardias.
The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
S57
A B S T R A C T S
- OP-130 Development of Arrhythmogenic Cardiac Cardiomyopathy in Patients with Ventricular Extrasystoles. Ashot Hovhannesyan. Yerevan Cardiology Institute. Aim: To find scintigraphic criterions of beginning of arrhythmogenic cardiomyopathy in patients with ventricular extrasystoli (VE). Material-Methods: 63 patients with ventricular extrasystoles was included in the study. 29 mean, 34 wemen. Mean age 29 e 63 year. Inclusion criterions into study was registered ventricular extrasystoli by 12 lead ECG, >4000 es/24h on Holther monitoring. In 16 patient electrophysiological study (EP) following radiofrequency ablation (RF) was performed. In 21 patients coronaroangiography was performed, no evidence of ischemic heart disease (IHD) was found. We exclude all patients with evidence of organic heart diseases, atrial arrhythmias and QT segment changes. 12 patients with no evidence of arrhythmia formed control group. In all patients Echocardiography with tissue doppler and synchronized myocardial quantitative gated SPECT was performed using 99Tc-pyrophospate using AnyScan Multimodality Imaging System. In RF ablation group myocardial quantitative gated SPECT was performed also 3 monts after procedure. Results: Areas of local asynchronous contraction was seen in all patients. Asynchronous contraction zones was the same with ECG what confirmed by intracardiac ECG during EP study. Echocardiography with tissue Doppler was less sensitive. We observed 3 kind of disturbances: when patients have only right, left or VE’s originated from both ventricles. And also multifocal (2 and more foci) VE’s seen in LV localizations. All this sites was estimated as electrical and mechanical heterogenic sites. In 38 patients (60,3%) VE’s arising from RV outflow tract, VE’s source localization and preliminary contraction areas was RV anterior wall. LV VE’s, especially monofocal, was located in sinus of Valsalva and asyncronious zones located in the septum. In LV VE group moderate LV dilatation and reduced contraction was observed. Conclusion: Zones of asyncroni on the scintigraphic phase polarity maps in patients with VE could considered as sign of ectopy and beginning of arrhythmogenic cardiomyopathy.
Novel Parameters fort he Prediction of Atrial Fibrillation Development Saturday, March 28, 2015 17:00 PM w 18:30 PM, Hall 8 (Abstract nos. OP-131 w OP-137)
- OP-131
O R A L
Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients?. Pakize Kirdemir1, Vedat Yildirim2, Ilker Kiris3, Senol Gulmen4, Erkan Kuralay5, Erdogan Ibrisim6, Ertugrul Ozal7. 1Department of Anesthesiology, University of Suleyman Demirel, Isparta, Turkey; 2Department of Anesthesiology and Reanimation, Gulhane Military Academy of Medicine, Ankara, Turkey; 3Department of Cardiovascular Surgery, S¸ifa University, Izmir, Turkey; 4Department of Cardiovascular Surgery, University of Suleyman Demirel, Isparta, Turkey; 5Department of Cardiovascular Surgery, Lokman Hekim Hospital, Ankara, Turkey; 6Department of Cardiovascular Surgery, Anatolia Hospital, Antalya, Turkey; 7 Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey. Objective: To compare continuous insulin infusion (CII) and intermittent subcutaneous insulin therapy for preventing supraventricular tachycardia. The authors propose that continuous insulin therapy is more effective to reduce supraventricular tachycardias. Material: Two hundred diabetic patients were included in this prospective randomized study. Patients were divided into 2 groups according to their insulin therapy in 2 different centers. Group 1 included 100 diabetes mellitus (DM) patients, and CIIs were administrated. These patients received a CII infusion titrated per protocol in the perioperative period (Portland protocol). Group 2 also included 100 DM patients, and subcutaneous insulin was injected every 4 hours in a directed attempt to maintain blood glucose levels below 200 mg/dL. Sliding scale dosage of insulin was titrated to each patient’s glycemic response during the prior 4 hours. Results: There were 5 hospital mortalities in the intermittent insulin group. The causes of death were pump failure in 3 patients and ventricular fibrillation in 2 patients. There were 2 hospital mortalities in the CII group (p ¼ 0.044). Thirty-six patients in the intermittent insulin group and 21 patients in the CII group required positive inotropic drugs after cardiopulmonary bypass (p ¼ 0.028). Low cardiac output developed in 28 and 16 patients in the intermittent and CII groups, respectively (p ¼ 0.045). Univariate analysis identified positive inotropic drug requirement (p ¼ 0.011, odds ratio [OR] ¼ 3.41), ejection fraction (EF) (p ¼ 0.001, OR ¼ 0.92), cross-clamp time (p ¼ 0.046, OR ¼ 0.97), left internal mammary artery (p ¼ 0.023, OR ¼ 0.49), chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second <75% of predicted value (p ¼ 0.009, OR ¼ 2.02), intra-aortic balloon pump (p ¼ 0.045, OR ¼ 1.23), body mass index (p ¼ 0.035 OR ¼ 5.60), and CII (p < 0.001, OR ¼ 0.36) as predictors of SVT. Stepwise multivariate analysis confirmed the significance of some of the previously mentioned variables as predictors of SVT. The value of -2 log likelihood of multivariate analyses was 421.504. These were EF (p < 0.001, OR ¼ 0.91), positive inotropic drug requirement (p < 0.001, OR ¼ 3.94), COPD (p ¼ 0.036, OR ¼ 2.11), and CII (p < 0.001, OR ¼ 0.19). Conclusion: Continuous insulin therapy in the perioperative period reduces infectious complications, such as sternal wound infection and mediastinitis, cardiac mortality caused by pump failure, and the risk of development of supraventricular tachycardias.
The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
S57
A B S T R A C T S