**8. Postoperative arrhythmias after non cardiac surgery**

Arrhythmias complicate postoperative period after non cardiac surgery in up to 5 -20 % of the times. (69) Again, AF seems to be the most common arrhythmia making up about 68% of the documented arrhythmias. (8) Benign ventricular rhythms like ectopics or NSVT occur in up to 5 -25% of the patients and sustained VT is rather rare occurring in less than 1% of the cases. (70)

The rate of incidence after non-cardiac surgery also seems to depend on the type of surgery. Non vascular abdominal surgery, especially colorectal surgery seems more prone with rates of around 20%. The incidence seems increased after any instance of thoracotomy (10%) as well. In other instances the rate is around 0.01% after ophthalmologic surgery and 4% after orthopedic surgery.

The risk factors seem to be similar to those implicated in post cardiac surgery including male sex, increased age > 70y, heart valve disease, prior history of arrhythmia, co existing asthma, congestive heart failure, and hypertension. (71) Post operative causes include electrolyte imbalances, hypoxia, and hypercarbia. (72) Sepsis seems to be a recurring factor implicated as a causative factor of arrhythmias. In fact all kinds of stress inducing causes like stroke, Gastrointestinal bleed, Pulmonary Embolism, Myocardial Infarction, pulmonary edema and others have been implicated. Some specific factors noted to cause postoperative arrhythmias also include anastomotic leak (77) or acute alcohol withdrawal. (69) Increased vagal tone due to anesthetic practices like laryngoscopy is also a risk factor for any bradyarrhythmia.

Apart from associated morbidity similar to post cardiac surgery arrhythmias, post noncardiac surgery arrhythmias can also cause mortality of around 12 – 50%. (72, 73, 74)

### **Management:**

No large scale randomized trials validating the treatment of post non-cardiac surgery arrhythmias are available. However the management can be closely extrapolated from both post cardiac surgery treatment and non-surgical related general cardiology treatment protocols. Initial priority is to assess the physiological impact and stabilize the patient hemodynamically while searching for the specific causes that initiated the rhythm disturbance. One needs to rectify these issues while simultaneously initiating specific therapy to halt the arrhythmia. Specific treatment methods for individual rhythms are similar to the approach already explained for post cardiac surgery arrhythmias.

In conclusion, postoperative arrhythmias, especially AF are common and are associated with significant morbidity and mortality but can be prevented to some extent. Further research is required to completely understand causes of such arrhythmias and to improve their prevention and treatment.

Post Operative Arrhythmias 253

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