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Title: The evaluation of rhythm disturbances with Holter ECG monitoring in patients undergoing coronary artery bypass grafting treated with nitroglycerin or diltiazem

Andrzej Stachurski, Tomasz Hirnle, Marta Negrusz-Kawecka, Krzysztof Namięta, Wojciech Stupiński, Tadeusz Bross
Original articles
Polish Journal of Cardiology
Start page:
Final page:
coronary artery bypass grafting, rhythm disturbances, diltiazem, nitroglycerin

Objective: Hemodynamic problems resulting from cardiac arrhythmias often occur in patients undergoing co-ronaro-artery bypass grafting (CABG) in the early postoperative period. This generally benign problem can increase surgical morbidity and delay recovery. Aim of the study: The aim of this study was to evaluate the antiarrhythmic effects of intravenous diltiazem com-pared with nitroglycerin (NTG) in patients undergoing CABG. Material and methods: The study group consisted of 49 patients (30 men and 19 women, aged 38-75 years, mean 56.5 years SD 8.9) with coronary artery disease (CAD) who underwent CABG. The patients were ran-domly assigned to NTG (n=25) or diltiazem (n=24). lntravenous medication was started immediately after cardio-pulmonary bypass (CPB). In order to assess the effects of NTG or diltiazem on rhythm disturbances for the period of 24 h ECG Holter monitoring was performed. Arrhythmia was defined as ventricular ecto-pic systole - VES, couplets, non-sustained ventricular tachycardia - VT, supraventricular ectopic systole -SVES, supraventricular tachycardia - SVT and paroxysmal atrial fibrillation - PAR VES, VT, SVES, SVT and PAF were measured in 8 time periods every 3 hours. Results: The two groups did not differ regarding preoperative and operative characteristics. The mean num-ber of VES per one patient was higher in NTG group in the first hours after operation (period 1 -3). Sińce the 4th period to the end of observation the mean number of VES was higher in nitroglycerin group than in diltiazem group, but the differences were not statistically significant. The frequency of occurrence of VES was similar in both groups. The mean number of SVES was similar in both groups in following periods (except for the 2nd and 3rd period). There were no significant differences of SVES occurrence between the diltiazem and NTG group in all periods. The mean number of couplets and non-sustained VT was similar in both groups. The number of PAF was higher in NTG group, but the differences were not significant. Conclusions: 1. Diltiazem in comparison with nitroglycerin insignificantly Iowers the frequency of PAF occurrence in ear-ly period after CABG. 2. Diltiazem and nitroglycerin have similar effect regarding the frequency of occurrence of SVES and VES in early post-CABG period.