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, during Intensive Care Unit (ICU) admission, at ward admission, and at 6 months and 2 years postoperatively. Left Ventricular Ejection Fraction (LVEF) was assessed longitudinally.

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.