Ventricular Arrhythmias following Mitral Valve Replacement

Control with Intra-aortic Balloon Counterpulsation

¹ From the Department of Surgery, Division of Cardiothoracic Surgery, the Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pa.

Two patients with severe left ventricular failure (New York Heart Association's class 4) secondary to acute mitral insufficiency underwent mitral valve replacement after their condition had been stabilized by intra-aortic balloon counterpulsation. The need for hemodynamic support declined rapidly following valve replacement in both cases, but when the frequency of balloon counterpulsation was reduced, the immediate onset of life-threatening arrhythmias was noted. The resumption of 1:1 intra-aortic balloon counterpulsation always immediately abolished the arrhythmia. The dependency upon counterpulsation for arrhythmia suppression gradually diminished, and after a week the intra-aortic balloon was removed from the second patient, who subsequently made a complete recovery. The intra-aortic balloon was removed from the first patient four days after surgery and one day after its antiarrhythmic effect had been noted. Twenty-four hours later, this patient succumbed to a ventricular tachycardia which terminated in ventricular fibrillation. When no surgically correctable lesion is present, prolonged use of the intra-aortic balloon is recommended for all patients who develop ventricular or low nodal arrhythmias in response to decreasing the frequency of counterpulsation. As in our second patient, this will on occasion save a very high-risk patient.