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Arrhythmias in Children in Early Postoperative Period After Cardiac Surgery
Manoj Kumar Sahu1, Anupam Das1, Bharat Siddharth1
11 Department of Cardiothoracic and Vascular Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India.
Insights
Postoperative arrhythmias, particularly junctional ectopic tachycardia, occurred in 6.7% of pediatric cardiac surgery patients. Higher Aristotle scores and longer surgical times were associated with increased arrhythmia risk.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative arrhythmias are a recognized complication following surgical repair of congenital heart disease.
- Understanding their incidence and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence, risk factors, and management of postoperative arrhythmias in pediatric patients undergoing elective open-heart surgery.
- To identify specific patient and surgical factors associated with arrhythmia development.
Main Methods:
- Retrospective review of 369 pediatric patients (<18 years) undergoing elective open-heart surgery.
- Continuous electrocardiographic monitoring in the intensive care unit.
- Analysis of patient factors including Aristotle Basic Complexity Score, surgical duration, hypotension, tachycardia, serum lactate, and inotropic score.
Main Results:
- Arrhythmias occurred in 6.7% of patients, with junctional ectopic tachycardia (JET) being the most common (60% of arrhythmias).
- Higher Aristotle score, longer surgical duration, hypotension, tachycardia, elevated serum lactate, and higher inotropic score were significantly associated with arrhythmia occurrence.
- Specific congenital heart defect repairs, such as tetralogy of Fallot (TOF) and transposition of the great arteries (TGA), were linked to a higher risk of arrhythmias.
Conclusions:
- The incidence of postoperative arrhythmias in this pediatric cohort was low, with JET being the most frequent type.
- Risk factors for arrhythmias include complex congenital heart disease, prolonged surgical times, and hemodynamic instability.
- Efficient management strategies are available for these postoperative arrhythmias.
Background:
Postoperative arrhythmias are a known complication after cardiac surgical repairs for congenital heart disease.
Methods:
Data were reviewed pertaining to incidence, diagnosis, potential risk factors, and management of postoperative arrhythmias in 369 consecutive patients under 18 years of age, undergoing elective open heart surgery. All children were admitted to the intensive care unit and continuous electrocardiographic monitoring was performed. Patient factors such as Aristotle Basic Complexity Score, total surgical duration, hypotension, tachycardia, serum lactate level, and inotropic score were analyzed. Univariate analysis was done to assess associations between these factors and the occurrence of postoperative arrhythmias.
Results:
Twenty-five (6.7%) patients developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia occurring in 15 (60%) patients, followed by supraventricular tachycardia in 3 (12%), ventricular premature contractions in 3 (12%), hemodynamically unstable ventricular tachycardia and fibrillation in 3 (12%), and atrial fibrillation in 1 (4%) patient. Different grades of heart block were noted in 13 patients. Aristotle score (P = .014), total surgical duration (P < .01), hypotension (P = .02), heart rate (beats per minute) (P = .001), serum lactate level (P = .04), and inotropic score (P = .02) in the early postoperative period were associated with arrhythmia occurrence. Surgeries for ventricular septal defect alone or in association with other diseases including tetralogy of Fallot (TOF) and transposition of the great arteries (TGA) were found to be associated with higher risk of arrhythmias.
Conclusion:
This study showed a low incidence of arrhythmias, JET being the commonest, seen more in TOF repair and these could be treated efficiently. Higher Aristotle score, longer surgical time, hypotension, tachycardia, high inotropic score, and high serum lactate levels were associated with the occurrence of arrhythmias postoperatively.
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