Clinical and Echocardiographic Correlates of Symptomatic Tachydysrhythmias After Noncardiac Thoracic Surgery

Supraventricular tachydysrhythmias (SVTs) following thoracic surgery occur with significant frequency and may be associated with increased morbidity. Prospective data on the etiology and importance of these dysrhythmias are sparse. In 100 patients undergoing pulmonary resection without history of atrial dysrhythmias or previous thoracic surgery, we examined the effects of predefined risk factors by history, pulmonary function, and echocardiography on the incidence of postoperative SVT. Serial echocardiograms were performed preoperatively, on postoperative day 1, and again between postoperative days 2 to 6 (median=3) to evaluate cardiovascular function and to estimate right ventricular systolic pressure (RVSP) by the tricuspid regurgitation jet (TRJ) Doppler velocity method. Symptomatic postoperative SVT occurred in 18 (18%) of the 100 patients studied at a median of 3 days after surgery and was disabling in 12 of 18 (67%). Digoxin loading was ineffective in controlling the ventricular response in 16 of 17 episodes. In the patients developing SVT, postoperative echocardiography revealed significant elevation of TRJ Doppler velocity (2.7±0.6 m/s vs 2.3±0.6 m/s, p