Postoperative Cardiac Arrhythmias in Children

The cardiac rhythm can be very labile in the early postoperative period, necessitating a high degree of vigilance. Bradycardia may be due to sinus node dysfunction or varying degrees of atrioventricular block, both of which are usually due to surgical trauma. Temporary pacing, using implanted temporary pacing wires, should be readily available. Most often, bradycardias are transient. Patients who fail to recover an adequate sinus rhythm or atrioventricular conduction within 7 to 10 days should be treated with a pacemaker. Supraventricular tachycardia, ventricular tachycardia, and junctional ectopic tachycardia are the major tachyarrhythmias of the early postoperative period. Establishing the diagnosis may require electrocardiography, atrial electrocardiograph recordings, and the use of intravenous adenosine. The management options for patients with tachyarrhythmias include vagal maneuvers, hypothermia, pacing, drug therapy, catheter ablation, direct-current cardioversion, and adjuvant measures. Electrolytes and acid-based balance should be checked in all patients with an arrhythmia and optimized if necessary.