Electrophysiological Basis for Supraventricular Arrhythmias: Following Surgical Procedures for Aortic Stenosis

doi:10.1001/archsurg.1971.01350110122020

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Vol. 103 No. 5, November 1971

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PAPERS READ BEFORE THE NINETEENTH SCIENTIFIC MEETING OF THE INTERNATIONAL CARDIOVASCULAR SOCIETY, PHILADELPHIA, JUNE 17-18, 1971

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Electrophysiological Basis for Supraventricular Arrhythmias

Following Surgical Procedures for Aortic Stenosis

Harry L. Bush, Jr., MD; Henry Gelband, MD; Brian F. Hoffman, MD; James R. Malm, MD

AMA Arch Surg. 1971;103(5):620-625.

Abstract

Fifty-eight patients with isolated aortic stenosis who underwentopen heart surgery during a three-year period had a 49% incidenceof postoperative supraventricular arrhythmias (SVAs). Of the22 patients under 20 years of age (group A), four (18%) hadpostoperative SVAs, in contrast to 24 of the 36 patients (66.7%)over 40 years of age (group B). The increase in SVAs in groupB was due to increased frequency of atrial flutter-fibrillation.The electrophysiologic characteristics of the right atrial myocardiumwere normal in group A, but were markedly abnormal in groupB. The diffuse spontaneous phase-4 depolarization, local conductiondisturbances, and abnormal transmembrane action potential characteristicsfound in group B could result in multifocal ectopic pacemakersand reentry arrhythmias. Therefore, the majority of the postoperativeSVAs in group B may be related to the preoperative cellularabnormalities of their right atrial myocardium.

Author Affiliations

New York

From the Department of Surgery, College of Physicians and Surgeons, Columbia University; and the Surgical Service, Presbyterian Hospital, New York (Drs. Bush and Malm); and the Department of Pharmacology, Columbia University, New York (Drs. Gelband and Hoffman). Dr. Bush is now with the US Naval Hospital, Patuxent River, Md.

Footnotes

Accepted for publication July 6, 1971.

Read before the 19th scientific meeting of the InternationalCardiovascular Society, Philadelphia, June 18, 1971.

Reprint requests to 622 W 168th St, New York 10032 (Dr. Malm).

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