SIGNIFICANT REDUCTION OF VENTRICULAR ARRH YTHMIAS AND NECROSIS MARKERS BY PERIOPERATIVE DILTIAZEM ADMINISTRATION IN CORONARY-ARTERY BYPASS-GRAFTING

In the present study, the effect of the calcium channel antagonist dil tiazem on the occurrence of ventricular arrhythmias (Lown class IV) in the early postoperative period as well as its influence upon markers of necrosis were evaluated in patients undergoing coronary artery bypa ss grafting (ACB). The effect of diltiazem was compared with that of n itroglycerin (NTG). 40 consecutive ACB patients were randomly assigned to a perioperative therapy with either diltiazem (n = 20) or NTG (n = 20). The incidence of ventricular arrhythmias was controlled preopera tively and at three postoperative days using long-term ECG. The myoglo bin values were measured pre-, peri-, and postoperatively as well as a dditionally the pre- and postoperative values of CK and CK-MB. The per ioperative administration of diltiazem significantly reduced the incid ence of postoperative ventricular arrhythmias compared with the NTG th erapy. The values for markers of necrosis, especially for myoglobin, w ere markedly higher in the NTG group than in the diltiazem group. Thus , the extent of myocardial cell destruction seems to be lower under di ltiazem and is compatible with the reduced incidence of ventricular ar rhythmias as a functional correlate of ischemia. Consequently, diltiaz em is recommended as a standard adjunct of perioperative medication in cardiac surgery.