Accelerated junctional rhythm following open heart surgery may lead to hemodynamic impairment due to loss of synchronized atrial contraction. Therefore, in this study we evaluated the frequency, duration, and hemodynamic effects of accelerated junctional rhythm in 30 patients undergoing coronary artery bypass (CAB) and in 30 undergoing valve replacement (VR). Accelerated junctional rhythm was defined as a rate greater than 55 bpm. Patients were continuously monitored postoperatively and rhythm strips obtained at least every 4 hours. Ten VR patients (33%) and four CAB patients (13%) exhibited accelerated junctional rhythm, the difference between these groups being significant (p less than 0.02). Nine of the 14 were hemodynamically compromised requiring inotropic support (9) and/or pacemaker insertion (2). The time of appearance of accelerated junctional rhythm ranged from immediate to 6 days (mean 26 +/- 52 hours, SD) and it lasted a mean of 16 +/- 22 hours. The rate ranged from 62 to 150 bpm. The sinus rate prior to the onset of accelerated junctional rhythm was significantly lower than the sinus rate in those not developing accelerated junctional rhythm. In conclusion, accelerated junctional rhythm is seen frequently following open heart surgery and may lead to hemodynamic deterioration. It is seen more frequently following VR, in approximately 33% of patients. Its manifestation appears to result from a combination of acceleration of junctional focus and slowing of sinus node discharge.
Coronary Artery Bypass Digoxin