High incidence of sudden death late after anterior LV-aneurysm repair

Objectives: Sudden death due to ventricular arrhythmias occurs frequently among patients with dilated cardiomyopathy and congestive heart failure (CHF). In patients with left ventricular (LV) aneurysms, LV-aneurysm repair (LVAR) reduces LV-size and ameliorates symptoms of CHF. but the incidence of late sudden death is unknown, especially after LVAR without concomitant anti-arrhythmic therapy. Methods: Between June 1993 and June 1999, 147 patients (70% males; 62 +/- 9 years) with CHF (median: NYHA III) due to anterior LV-aneurysms underwent LVAR. None of the patients underwent anti-arrhythmic Surgical procedures concomitant to LVAR. Ninety percent of the patients had additional myocardial revascularization. Hospital records and laevocardiograins were reviewed, and follow-up information was obtained. Results: In-hospital mortality was 4.1% (n = 6). The median follow-up was 3.7 years (0.1-73.4 months; overall 462 patient-years). At follow-up. the patients had significantly less symptoms than preoperatively (median: NYHA II, P < 0.001). Nineteen patients had died (5-year survival rate 78%). Of these late deaths, 84% (n = 16) were cardiac-related, among which sudden death was most frequent (n = 7). Predictors of sudden death were a bypass graft to the right coronary artery (P = 0.0100), ventricular tachyarrhythmias early postoperatively (P = 0.0315), and cross-clamp time (P = 0.0496). Conclusions: Although the survival and functional state of most patients were good after LVAR without concomitant anti-arrhythmic surgery, we observed a high incidence of late sudden death, which was-among others-significantly associated with postoperative ventricular tachyarrhythmias. To further improve outcomes, intra- and postoperative anti-arrhythmic therapy is advisable in patients undergoing LVAR. (C) 2004 Elsevier B.V. All rights reserved.