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 laevocardiograms 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.