Arrhythmias After Video Assist Thoracoscopy

We read with interest the article entitled “Thoracic Epidural Bupivacaine Attenuates Supraventricular Tachyarrhythmias After Pulmonary Resection” (1). Almost all of our patients who are scheduled for thoracotomy receive epidural for postoperative analgesia. In addition to the improved pain control and improved pulmonary function postoperatively, a less frequent occurrence of arrhythmias is yet an additional reason that epidural analgesia should be provided. Some patients who undergo video-assisted thoracoscopy (VAT) also receive epidural catheters for postoperative pain management. This population was not addressed in the current study. We would like to point out our previously published report that was not cited in your article (2). In our retrospective review, we reported a less frequent incidence of postoperative arrhythmias in patients who underwent VAT who received epidural analgesia compared with patients who did not have epidural analgesia. Of 51 patients who did not have epidural analgesia, 8 had postoperative supraventricular tachycardia, compared with 0 of 30 patients who had epidural analgesia. The use of epidural catheters for postoperative pain management is also beneficial in patients who have undergone VAT.