Electrophysiological basis for supraventricular arrhythmias: following surgical procedures for aortic stenosis.

Fifty-eight patients with isolated aortic stenosis who underwent open heart surgery during a three-year period had a 49% incidence of postoperative supraventricular arrhythmias (SVAs). Of the 22 patients under 20 years of age (group A), four (18%) had postoperative SVAs, in contrast to 24 of the 36 patients (66.7%) over 40 years of age (group B). The increase in SVAs in group B was due to increased frequency of atrial flutter-fibrillation. The electrophysiologic characteristics of the right atrial myocardium were normal in group A, but were markedly abnormal in group B. The diffuse spontaneous phase-4 depolarization, local conduction disturbances, and abnormal transmembrane action potential characteristics found in group B could result in multifocal ectopic pacemakers and reentry arrhythmias. Therefore, the majority of the postoperative SVAs in group B may be related to the preoperative cellular abnormalities of their right atrial myocardium.

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