Cardiac arrhythmias during cardiopulmonary testing as predictors of an unfavorable early postoperative course in patients with chronic thromboembolic pulmonary hypertension

Objective. To study the impact of cardiac arrhythmias in patients with chronic thromboembolic pulmonary hypertension during the early post-operative period. Materials and methods. During this research, 194 patients with chronic thromboembolic pulmonary hypertension, who underwent pulmonary thromboendarterectomy, were examined. Patients were divided into two groups: the 1st group — 48 patients with detected cardiac arrhythmias (CAs) in the form of ventricular arrhythmias (VAs) during a cardiopulmonary exercise testing (CPET), the 2nd group — 146 patients in whom CAs were not registered during CPET. Results. Patients in the 1st group had CAs as single and paired ventricular extrasystoles. There was a shorter duration of CPET and a smaller proportion of patients in the 1st group who reached the anaerobic threshold in addition to significant disruption of pulmonary gas exchange and cardiovascular reactivity compared to the 2nd group. The early post-operative period in patients of the 1st group was different from that of patients of the 2nd group by a higher proportion of patients with the development of acute renal failure and new cases of CAs as well as the longest hospital stay. The revealed VAs during CPET increase the risk of developing CAs in the early post-operative period — OR 3.59 (2.41—6.84; p=0.002) and prolongate the length of hospital stay — OR 2.75 (2.01—4.58; p=0.03). Conclusion. Ventricular arrhythmias in patients with chronic thromboembolic pulmonary hypertension detected during cardiopulmonary exercise testing negatively affect the early post-operative period, increasing the risk of cardiac arrhythmias after surgery and length of hospitalization. The introduction of methods of screening and prevention of cardiac arrhythmias at the stage of preoperative preparation of patients will potentially improve treatment effectiveness and quality of life after surgery.