How to Reveal Arrhythmias in Vascular Surgery Patients

In Europe, with an overall population of approximately 490 million, crude estimates of 7 million major surgical procedures are conducted annually. Cardiac events, such as myocardial infarction (MI) and cardiac death, are a major cause of perioperative morbidity and mortality in these patients. After major surgery the incidence of cardiac death varies between 0.5% and 1.5%, with non-fatal cardiac complications ranging between 2.0% and 3.5%. When applied to the European population these figures translate into 150,000 to 250,000 life-threatening cardiac complications due to non-cardiac surgical procedures annually. The risk of perioperative cardiac complications depends on the condition of the patient prior to surgery, the prevalence of co-morbidities, and the magnitude and duration of the surgical procedure. Despite the decline in complication rates over the past decades, perioperative adverse cardiac events still remain a significant problem, therefore persisting as an area of clinical interest and concern. Cardiac arrhythmias are of special interest, due to their unique place within the pathophysiology of perioperative cardiac adverse events. Firstly, arrhythmias can be of diagnostic value, if detected early in the perioperative period. There is often an instigating factor for an arrhythmia to occur in a postoperative patient. These are usually transient incidents, such as hypoxemia, cardiac ischemia, catecholamine excess, or electrolyte abnormalities, which warrant immediate treatment to prevent further complications. This includes correction of these imbalances and medical therapy directed at the arrhythmia itself. Secondly, arrhythmias can be considered as an adverse cardiac event on its own, enhancing thromboembolic processes, resulting in stroke and death in some cases. Following both cardiac and non-cardiac surgical procedures, arrhythmias are common and represent a major source of postoperative morbidity. Arrhythmias are therefore both of diagnostic and prognostic value to treating physicians. However, the majority of arrhythmias is asymptomatic and often transient, causing them to be frequently missed.

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