Question about post op dysrhytmias

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Hi Everyone!

My patient had a mitral valve repair done and after the surgery she was in junctional rhythm and stayed in that rhythm for a quite a few days before converting to sinus bradycardia. My professor would like to know what caused her to have those rhythms post-op. I've been reading and I really don't have any idea. Would anyone be able to point me in the right direction to figure this out??

Thanks for all your help! :)

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Specializes in ICU.
Hi Everyone!

My patient had a mitral valve repair done and after the surgery she was in junctional rhythm and stayed in that rhythm for a quite a few days before converting to sinus bradycardia. My professor would like to know what caused her to have those rhythms post-op. I've been reading and I really don't have any idea. Would anyone be able to point me in the right direction to figure this out??

Thanks for all your help! :)

Look at this article:

Conduction disturbances after superior septal approach for mitral valve repair

http://ats.ctsnetjournals.org/cgi/content/full/68/4/1262

In some heart surgeries, the conduction pathways may be disturbed (either temporarily or permanently). If the "normal" pathway was mucked up, backup pacemakers will take over until the regular AV/SA nodes can control things again. Much like in some heart attacks, certain heart blocks can occur depending on what region of the heart is damaged (and what electrical pathways pass through that region).

In your patient's case, I suspect that the junctional rhythm occurred due to a disturbance (blockage) in the regular SA-AV node conduction system. Once the surgically chopped heart tissue healed sufficiently, the conductive pathway worked again, allowing the sinus node to control things.

If the mitral valve issue was a long term problem (like mitral valve prolapse with regurgitation), often the atrium is enlarged from high pressure blood flowing backwards during systole, resulting in atrial fibrillation even after valve repair/replacement. Sometimes a Maze procedure is done to address this (with varying chances of success).

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That makes sense. Thanks so much for your help!:)

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