Cardiac Arrhythmias Following Left Ventricular Aneurysm Resection: A 10-Year Retrospective Study

Left Ventricular Aneurysm (LVA) is a serious complication of myocardial infarction that can lead to impaired ventricular function and life-threatening ventricular arrhythmias. Data on perioperative arrhythmic patterns and associated clinical factors following LVA resection, particularly with long-term follow-up, remain limited. We aimed to characterize perioperative arrhythmias and their clinical correlates following surgical LVA resection with mid-term follow-up.

Retrospective cross-sectional study with longitudinal ECG and echocardiographic follow-up, 29 patients who underwent surgical LVA resection between 2011 and 2022 at a tertiary cardiac center were evaluated. Demographic characteristics, comorbidities, lipid status, perioperative complications, Electrocardiographic (ECG) findings, echocardiographic parameters, length of hospital stay, and mortality were extracted from medical records and follow-up assessments. ECGs were analyzed preoperatively, immediately after surgery, during Intensive Care Unit (ICU) admission, and at ward admission. Left Ventricular Ejection Fraction (LVEF) was assessed longitudinally during ICU admission, at ward admission, and at 6 months and 2 years postoperatively.

Preoperative ventricular arrhythmias were observed in 34.5% of patients, while atrial fibrillation was present in 17.2%, with no significant sex-based differences. Postoperative arrhythmias occurred in 20.7% of patients. While 72.4% of patients had normal ECGs at ICU admission, observed abnormalities were significantly more frequent among male patients (p = 0.040). Dyslipidemia was associated in univariable analysis with abnormal postoperative ECG findings during ICU and ward admission (p = 0.012 and p = 0.047, respectively). Mean LVEF improved significantly from 33.4% ± 8.1% preoperatively to 42.9% ± 6.9% at 2-year follow-up (p < 0.05). Six patients died during the early postoperative period, primarily due to low cardiac output syndrome and cardiac tamponade; two additional deaths were identified during follow-up, with undetermined causes.

Surgical resection of LVA is associated with significant improvement in left ventricular function; however, cardiac arrhythmias remain relatively common in the perioperative period. Male sex and dyslipidemia appear to be associated with a higher burden of postoperative ECG abnormalities.

These findings underscore the importance of meticulous perioperative monitoring and risk-factor optimization, and closer monitoring of cardiovascular risk factors may be warranted following LVA resection.