Utility of temporary atrial epicardial electrodes in postoperative pediatric cardiac patients

The utility of atrial electrograms recorded from temporary bipolar atrial epicardial electrodes in postoperative pediatric cardiac patients was assessed by (1) examining the accuracy of the surface electrocardiographic tracings and (2) analyzing the treatment modalities used for the arrhythmias diagnosed on the basis of the atrial electrograms. Atrial electrograms were obtained simultaneously with single-lead surface electrocardiographic recordings from 20 pediatric patients (ages 7 months to 11 years) after intracardiac repair of congenital heart defects. Interpretations of 25 surface recordings by five pediatric cardiologists were compared with analyses of the electrograms. Sinus rhythm was interpreted correctly by most reviewers 100% of the time, whereas atrioventricular conduction disturbances and narrow QRS tachycardias were identified correctly 77% and 14% of the time, respectively. Of those rhythms incorrectly interpreted, 89% had some type of active therapeutic intervention. Single-lead surface electrocardiographic recordings are imprecise for evaluating postoperative rhythms in pediatric cardiac patients, and our experience suggests that rhythms for which active intervention is necessary may be more difficult to interpret correctly by surface monitoring alone.