Incidence, Risk Factors, and Outcome of Cardiac Arrhythmia Postcardiac Surgery in Children

Prevalence and risk factors analysis of early postoperative arrhythmia after congenital heart surgery in pediatric patients

Background

Arrhythmia is one of the most common complications after cardiac surgery. The objectives of this study were to determine the prevalence and analyze the risk factors of postoperative arrhythmia in pediatric patients after cardiac surgery for congenital heart defects (CHD) at a single center in Bali, Indonesia over 2 years period.

Methods

A cross-sectional study, among 120 pediatric patients with CHD who underwent cardiac surgery, 92 patients met inclusion criteria in this study. The data were taken from medical records included demographic data, anthropometry, electrocardiography, surgical procedures, perioperative parameters, electrolyte levels, and management of postoperative arrhythmias.

Results

Among 92 patients, 14 (15.2%) developed postoperative arrhythmias. Complete heart block (CHB) the most common arrhythmia, observed in five patients (35.7%), followed by supraventricular tachycardia three patients (21.4%). There were statistically significant differences between arrhythmia and nonarrhythmia groups for cardiopulmonary bypass (CPB) duration (171.23 vs. 108.01 min), aortic cross-clamp duration (115.58 vs. 73.59 min), ischemia duration (106.33 vs. 65.43 min), and potassium level (3.33 vs. 3.88 mmol/L) with p < .05. Based on multivariate linear regression analysis, CPB time and potassium level were found to be independent risk factor.

Conclusions

Early postoperative arrhythmia observed 15.2% in this study, dominated by CHB. CPB duration, aortic cross-clamping, ischemia time, and potassium level were statistically significantly different between arrhythmia and nonarrhythmia groups.

Postoperative Cardiac Arrhythmias in Pediatric and Neonatal Patients with Congenital Heart Disease-A Narrative Review

Cardiac arrhythmias are a frequent complication in the evolution of patients with congenital heart disease. Corrective surgery for these malformations is an additional predisposition to the appearance of arrhythmias. Several factors related to the patient, as well as to the therapeutic management, are involved in the etiopathogenesis of cardiac arrhythmias occurring post-operatively. The risk of arrhythmias in the immediate postoperative period is correlated with the patient's young age and low weight at surgery. The change in heart geometry, hemodynamic stress, and post-surgical scars represent the main etiopathogenic factors that can contribute to the occurrence of cardiac arrhythmias in the population of patients with operated-on congenital heart malformations. Clinical manifestations differ depending on the duration of the arrhythmia, underlying structural defects, hemodynamic conditions, and comorbidities. The accurate diagnosis and the establishment of specific management options strongly influence the morbidity and mortality associated with arrhythmias. As such, identifying the risk factors for the occurrence of cardiac arrhythmias in the case of each patient is essential to establish a specific follow-up and management plan to improve the life expectancy and quality of life of children.

Risk factors of early postoperative cardiac arrhythmia after pediatric cardiac surgery: A single-center experience

OBJECTIVES

To evaluate the incidence of arrhythmia in the early postoperative period and to identify its risk factors among pediatric patients following cardiac surgery at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between 2015-2020.

METHODS

Out of 1242 patients, a total of 821 aged <18 years who underwent cardiac surgery were included in this retrospective cohort carried out in June 2021 at KAUH, Jeddah, Saudi Arabia. Information retrieved from the hospital medical records had patients' demographics, types of arrhythmias, hemodynamic stability, electrolyte disturbances, cardiopulmonary bypass (CPB), and aortic cross-clamp (AXC) durations. Univariate and multivariate logistic regression analyses were used to evaluate the possible risk factors associated with postoperative arrhythmia.

RESULTS

Of the 821 patients, 140 (17.1%) developed arrhythmia postoperatively. The most common arrhythmias were junctional ectopic tachycardia (JET, 51.4%), atrioventricular block (27.1%), and supraventricular tachycardia (10%). The majority of cases occurred on the first day postoperatively (79.3%). Patients with postoperative arrhythmias had a more prolonged CPB (p=0.0001) and AXC (p=0.005) time, electrolytes disturbances (p=0.021), and hemodynamic instability (p=0.0001) than other patients.

CONCLUSION

Postoperative arrhythmia, especially JET, is common after pediatric cardiac surgery. Prolonged cardiopulmonary bypass, prolonged aortic cross-clamping, electrolytes disturbances, and hemodynamic instability are possible risk factors for postoperative cardiac arrhythmias.

Early postoperative arrhythmias after pediatric congenital heart disease surgery: a 5-year audit from a lower- to middle-income country

Background

Arrhythmias are known complication after surgery for congenital heart disease (CHD). This study aimed to identify and discuss their immediate prevalence, diagnosis and management at a tertiary care hospital in Pakistan.

Methods

A retrospective study was conducted at a tertiary care hospital in Pakistan between January 2014 and December 2018. All pediatric (<18 years old) patients admitted to the intensive care unit and undergoing continuous electrocardiographic monitoring after surgery for CHD were included in this study. Data pertaining to the incidence, diagnosis, and management of postoperative arrhythmias were collected.

Results

Amongst 812 children who underwent surgery for CHD, 185 (22.8%) developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia, observed in 120 patients (64.9%), followed by complete heart block (CHB) in 33 patients (17.8%). The highest incidence of early postoperative arrhythmia was seen in patients with atrioventricular septal defects (64.3%) and transposition of the great arteries (36.4%). Patients were managed according to the Pediatric Advanced Life Support guidelines. JET resolved successfully within 24 hours in 92% of patients, while 16 (48%) patients with CHB required a permanent pacemaker.

Conclusions

More than one in five pediatric patients suffered from early postoperative arrhythmias in our setting. Further research exploring predictive factors and the development of better management protocols of patients with CHB are essential for reducing the morbidity and mortality associated with postoperative arrhythmia.

Clinical analysis of temporary pacemaker implantation in 13 children

BACKGROUND

At present, temporary pacemaker implantation is very common in the treatment of cardiovascular diseases in adults. However, the number of pediatric pacemakers implanted is still relatively small, and relevant research is also far less than that of adults. This study aimed to explore the application of temporary pacemakers in children with acute and critical cardiovascular diseases.

METHODS

The clinical data of children with cardiovascular diseases who were treated with temporary pacemakers in Tianjin Children's Hospital from October 2017 to February 2021 were analyzed retrospectively.

RESULTS

A total of 13 children with cardiovascular diseases were included in this study, including 4 males and 9 females, mean age of 71.2±56.3 months, and median body weight of 15.5 kg. There were 9 children with endocardial pacing and 4 children with epicardial pacing. The types of diseases included fulminant myocarditis (n=8), complete atrioventricular block (CAVB; n=1), and arrhythmias after open heart surgery (n=4). The median time from onset to admission was 1.0 days in children with endocardial pacing and there was cardiac arrest in 2 children, heart failure in 9 children, cardiogenic shock in 8 children, and Adams-Stokes attack in 7 children. The median time from admission to implantation of temporary pacemakers was 3.0 h and the operation time was 55.0±19.4 min. All 4 children with epicardial pacing had pacemakers implanted during operation because of CAVB. The pacing mode was VVI mode. The initial perceptual voltage was 1-2 mv, the output voltage was 5v, and the pacing frequency was 70-145 bpm. A total of 11 children reverted to sinus rhythm within 5.0 (1.8-34.0) h and the working time of temporary pacemakers was 134.0 (15.0-191.0) h. There was poor pacing in 2 children and catheter displacement in 1 child during pacing. A total of 12 children were followed up for 20.0±12.5 months and 1 was lost to follow-up. During the follow-up period, the cardiac functions were basically normal and no new arrhythmia appeared.

CONCLUSIONS

Temporary pacemakers have the advantage of simple operation, definite effect, and safety which has a remarkable effect in the treatment of acute and critical cardiovascular diseases in children.

Early postoperative arrhythmias in patients undergoing congenital heart surgery

Background

This study aims to evaluate early postoperative arrhythmias in children undergoing congenital cardiac surgery.

Methods

A total of 670 pediatric patients (355 males, 315 females; median age: 4 months; range, 1 day to 18 years) who underwent cardiac surgery due to congenital heart defects between December 2018 and November 2019 were included. The rate of postoperative arrhythmias, diagnosis, potential risk factors, and management strategies were evaluated. Multivariate regression analysis was used to identify significant factors of development of postoperative arrhythmias.

Results

Tachyarrhythmia was detected in 54 patients (8.1%), and the most common tachyarrhythmia was junctional ectopic tachycardia. Medical treatment was required in 25/38 (66%) of junctional ectopic tachycardia patients. Amiodarone was initiated in 18, dexmedetomidine in five, and flecainide + amiodarone in two of the patients. Different degrees of atrioventricular block were observed in 30 patients (4.5%). In 12 patients, permanent pacemakers were implanted during hospitalization. Age at the time of surgery under one-year-old, high inotropic scores, prolonged operation time, and high Aristotele"s scores were independent risk factors associated with early postoperative arrhythmia (p<0.05). The most common operations associated with early postoperative arrhythmia were left ventricular outflow tract, (6/20, 30%), complete atrioventricular septal defect (13/53, 24%), and tetralogy of Fallot (20/134, 14%) surgeries.

Conclusion

Cardiac arrhythmias are common in the early period after congenital heart surgery in children. The diagnosis and frequency of arrhythmias may vary according to different surgical procedures.