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Bedside evaluation of postoperative sinus node function in children
Insights
Postoperative sinus node dysfunction in children often follows congenital heart defect surgery. This study presents a safe bedside method to evaluate sinus node function using atrial electrodes, yielding data comparable to invasive methods.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Sinus node dysfunction is a common complication in children after surgical correction of congenital heart defects.
- Accurate and timely assessment of sinus node function is crucial for managing these patients postoperatively.
Purpose of the Study:
- To evaluate the efficacy of a simple and safe bedside method for assessing postoperative sinus node function in pediatric patients.
- To compare bedside measurements of sinoatrial conduction times (SACTs) and corrected sinus node recovery times (CSNRTs) with conventional methods.
Main Methods:
- Utilized atrial epicardial electrodes placed near the sinus node during surgery in 25 children.
- Measured sinoatrial conduction times (SACTs) and corrected sinus node recovery times (CSNRTs) within 3 days post-operation.
- Compared postoperative data with preoperative evaluations in a subset of patients.
Main Results:
- Twenty children (Group 1) exhibited normal sinus node function with mean SACTs of 122 ± 33 msec and CSNRTs of 165 ± 54 msec.
- Five children (Group 2) demonstrated sinus node dysfunction, with abnormal SACTs (≥230 msec) or sinus node entrance block.
- Bedside measurements showed no significant difference compared to preoperative assessments (p > 0.05).
Conclusions:
- Bedside evaluation of sinus node function using atrial epicardial electrodes is a feasible and safe approach in pediatric cardiac surgery patients.
- This method provides reliable data comparable to invasive techniques used during cardiac catheterization.
- Early detection of sinus node dysfunction allows for timely management and improved patient outcomes.
Abstract:
Sinus node dysfunction in children frequently results from the surgical correction of congenital heart defects. We evaluated postoperative sinus node function at the bedside in 25 children by utilizing atrial epicardial electrodes which were placed near the sinus node at the time of operation. Sinoatrial conduction times (SACTs) and corrected sinus node recovery times (CSNRTs) were determined within 3 days of operation in each patient. Group 1 consisted of 20 patients (aged 1 month to 13 years) with normal postoperative sinus node function. Mean (+/- SD) SACTs and CSNRTs were 122 +/- 33 msec (range 61 to 187 msec) and 165 +/- 54 msec (range 52 to 253 msec), respectively. Preoperative evaluation of sinus node function during cardiac catheterization showed that preoperative and postoperative SACTs and CSNRTs were not significantly different (p greater than 0.05) in any of nine patients. Group 2 was composed of five children (aged 1 to 14 years) with postoperative sinus node dysfunction. Three had abnormal SACTs of 230 msec or greater and two children had first-degree sinus node entrance block. Two patients had prolonged CSNRTs. Electrocardiographic (ECG) monitoring revealed evidence of sinus node dysfunction in four of the five patients in Group 2. This report describes a simple and safe means of evaluating postoperative sinus node function at the bedside. The data are comparable to those obtained using more conventional methods during cardiac catheterization.