Intraoperative electroencephalography predicts postoperative seizures in infants with congenital heart disease
Laurie E Seltzer1, Michael Swartz2, Jennifer M Kwon1
1Department of Neurology, University of Rochester Medical Center, Rochester, New York.
Insights
Infants undergoing deep hypothermic circulatory arrest for congenital heart defect surgery may show predictable EEG changes. A specific post-isoelectric pattern may indicate a risk for seizures within 48 hours.
Area of Science:
- Pediatric Cardiology
- Neurophysiology
- Neonatal Surgery
Background:
- Infants with congenital cardiac defects undergoing surgery face risks of reduced cerebral blood flow, especially during deep hypothermic circulatory arrest (DHCA).
- This compromised blood flow increases the likelihood of seizures and long-term neurodevelopmental issues in affected infants.
Purpose of the Study:
- To investigate electroencephalographic (EEG) changes in infants during and after deep hypothermic circulatory arrest (DHCA).
- To identify potential EEG patterns that may predict postoperative seizure development in this vulnerable population.
Main Methods:
- Continuous video-electroencephalographic (EEG) monitoring was performed on 32 infants with congenital heart disease.
- Monitoring occurred preoperatively, intraoperatively, and for 48 hours postoperatively, with a focus on periods of deep hypothermic circulatory arrest.
Main Results:
- EEG patterns became suppressed and isoelectric in all patients (n=17) requiring DHCA when temperatures dropped below 25°C.
- Two infants who underwent DHCA developed electrical seizures within 48 hours postoperatively. Their recovery EEG showed a distinct rhythmic, high-amplitude, sharp, and often asynchronous burst pattern.
Conclusions:
- Electroencephalography (EEG) monitoring reveals predictable changes in infants during deep hypothermic circulatory arrest (DHCA).
- A specific EEG pattern emerging after the isoelectric period may serve as a predictor for seizure development in the 48 hours following surgery.
Background:
During the surgical repair of infants with congenital cardiac defects, there can be periods of decreased cerebral blood flow, particularly during deep hypothermic circulatory arrest. As a result, these infants are at increased risk for seizures and long-term neurodevelopmental difficulties.
Methods:
Thirty-two infants with congenital heart disease had continuous video-electroencephalographic (EEG) monitoring pre-, intra-, and postoperatively for 48 hours after surgery.
Results:
For patients requiring deep hypothermic circulatory arrest (n = 17) the EEG pattern for all patients became suppressed and eventually isoelectric below 25 °C. Two of the 32 infants had electrical seizures within the 48-hour monitoring period. Both required deep hypothermic circulatory arrest, and the burst pattern during recovery had rhythmic, sharp components that were high amplitude and often asynchronous between the hemispheres. The interval between the onset of seizure activity and initiation of the sharp burst pattern during surgery was 29 and 40 hours. This pattern was not observed during isoelectric recovery from infants who did not develop postoperative seizures.
Conclusions:
The EEG in infants during deep hypothermic circulatory arrest displayed predictable changes. We identified an electroencephalographic pattern following the isoelectric period that may predict seizure development in the subsequent 48 hours.
