Critical arrhythmia in postoperative cardiac children: Recognition and management

Kabbani, Mohamed S.; Taweel, Hayan Al; Kabbani, Nasib; Ghamdi, Saleh Al

doi:10.4103/ajm.ajm_14_17

Cited by 16 publications

(6 citation statements)

References 22 publications

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“…Existing literature suggests an incidence of arrhythmias ranging from 7.3% to 48% in the early postoperative period after pediatric cardiac surgery [3][4][5][6]. Although they are transient and treatable in most cases, arrhythmias can be a cause of substantial morbidity and mortality [7]. Arrhythmias in the postoperative period can be attributed to patient-related risk factors, such as the nature and complexity of CHD itself, and surgery-associated risk factors, such as myocardial incision, sutures placed close to the conduction system, electrolyte disturbances, catecholamine stimulation, cardiopulmonary bypass (CPB)-related inflammation, residual hemodynamic impairment, and arrhythmogenic effects of drugs used commonly during postoperative care [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Although they are transient and treatable in most cases, arrhythmias can be a cause of substantial morbidity and mortality [7]. Arrhythmias in the postoperative period can be attributed to patient-related risk factors, such as the nature and complexity of CHD itself, and surgery-associated risk factors, such as myocardial incision, sutures placed close to the conduction system, electrolyte disturbances, catecholamine stimulation, cardiopulmonary bypass (CPB)-related inflammation, residual hemodynamic impairment, and arrhythmogenic effects of drugs used commonly during postoperative care [7][8][9]. While both tachyarrhythmia and bradyarrhythmia may be seen postoperatively, junctional ectopic tachycardia (JET) remains the most common postoperative arrhythmia [10].…”

Section: Introductionmentioning

confidence: 99%

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

Ishaque¹,

Akhtar²,

Ladak³

et al. 2022

Acute Crit Care

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Background: Postoperative arrhythmias are a known complication after surgical repair for congenital heart disease (CHD). This study aimed to identify and discuss the prevalence, diagnosis, and management of common rhythm disturbances seen in the immediate postoperative period after surgery for CHD in the pediatric population 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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ishaque¹,

Akhtar²,

Ladak³

et al. 2022

Acute Crit Care

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“…The association we observed in patients untreated versus treated with β‐blockers indicates that pre‐emptive β‐blocker administration could potentially attenuate the risk of postoperative JET associated with the Arg389Arg genotype. Evidence suggests that adrenergic antagonists—via reductions in adrenergic stimulation—decrease the risk of JET and could be a potential preventive therapy 32 . Specifically, dexmedetomidine, an α2‐adrenergic receptor agonist with sympatholytic effects, decreases the incidence of postoperative JET 33,34 .…”

Section: Discussionmentioning

confidence: 99%

“…Evidence suggests that adrenergic antagonists-via reductions in adrenergic stimulationdecrease the risk of JET and could be a potential preventive therapy. 32 Specifically, dexmedetomidine, an α2adrenergic receptor agonist with sympatholytic effects, decreases the incidence of postoperative JET. 33,34 Similarly, pre-operative use of propranolol, a nonselective βblocker, reduced the incidence of postoperative JET after TOF repair.…”

Section: Discussionmentioning

confidence: 99%

β1‐receptor polymorphisms and junctional ectopic tachycardia in children after cardiac surgery

Dumeny

Chantra

Langaee

et al. 2021

Clinical Translational Sci

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Junctional ectopic tachycardia (JET) is a potentially life‐threatening postoperative arrhythmia in children with specific congenital heart defects and can contribute significantly to postoperative morbidity for at‐risk populations. In adults, β1‐adrenergic receptor (ADRB1) and β2‐adrenergic receptor (ADRB2) genotypes have been associated with increased risk for arrhythmias. However, their association with arrhythmia risk in children is unknown. We aimed to test associations between ADRB1 and ADRB2 genotypes and postoperative JET in patients with congenital heart defects. Children who underwent cardiac surgery were genotyped for the ADRB1 p.Ser49Gly (rs1801252; c.145A>G), p.Arg389Gly (rs1801253; c.1165C>G), ADRB2 p.Arg16Gly (rs1042713; c.46A>G), and p.Glu27Gln (rs1042714; c.79G>C) polymorphisms. The occurrence of postoperative JET was assessed via cardiologist‐interpreted electrocardiograms. Genotype associations with JET were analyzed via logistic regression, adjusted for clinical variables associated with JET, with separate analysis in patients not on a β‐blocker. Of the 343 children included (median age 8 months, 53% boys, 69% European ancestry), 45 (13%) developed JET. The Arg389Arg genotype was not significantly associated with JET in the overall population (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 0.96–4.03, p = 0.064), but was nominally associated in patients not taking a β‐blocker (n = 324, OR = 2.25, 95% CI = 1.05–4.80. p = 0.034). None of the other variants were associated with JET. These data suggest that the ADRB1 Arg389Arg genotype may predict risk for JET following cardiac surgery in pediatric patients in the absence of β‐blockade. Whether treatment with a β‐blocker ameliorates this association requires further research.

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“…Arrhythmias are common after cardiac surgery for congenital heart disease [1][2][3][4] and are associated with increased morbidity, mortality, and length of stay. [4][5][6] Despite the significant clinical importance of rhythm identification, we rely on bedside surface electrocardiographic (ECG) monitors which are often inadequate for prompt and accurate rhythm identification due to the lack of clarity of atrial signals. 7,8 This may result in delayed, missed, or inaccurate diagnosis further jeopardizing care and patient health.…”

Section: Introductionmentioning

confidence: 99%

Improvements in Accuracy and Confidence in Rhythm Identification After Cardiac Surgery Using the AtriAmp Signals

Brown

Zhang

Al‐Subu

et al. 2023

J Intensive Care Med

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Objectives: Following cardiac surgery, 50% to 60% of patients with congenital heart disease will experience an arrhythmia. These arrhythmias are associated with increased morbidity and mortality. Therefore, rapid and accurate identification is paramount to the improvement of patient outcome. We hypothesize that the AtriAmp, a device which allows atrial electrogram (AEG) display on the bedside monitors, will increase provider accuracy and confidence in arrhythmia diagnosis. Design: A prospective observational study. Electrograms were collected from post-operative patients from the bedside monitors surface ECG and an AEG using the AtriAmp. A 12-question online survey was given to critical care and cardiology providers at 9 different programs across the country as well as being posted to the AAP SOCC fall newsletter. Six questions displayed signals from only the surface leads, while the other 6 showed the same arrhythmias with an AEG obtained from the AtriAmp. Answers were then evaluated for confidence and accuracy. A paired t-test along with mixed method modeling was used to assess the data. Setting: Cardiac pediatric ICU. Subjects: Providers in pediatric cardiology and pediatric critical care were evaluated on their ability to diagnose arrhythmias on surface ECG and AEG obtained from bedside monitor. Interventions: The accuracy and confidence of diagnosis of both surface and AEG signals were evaluated through an on-line survey. Results: Eighty-eight providers completed the survey. The study showed that interpreting with the AtriAmp signal, compared to the surface ECG only, significantly increased the accuracy ( P = .002) and confidence in provider rhythm diagnosis ( P < .001). Junctional ectopic tachycardia, sinus tachycardia, and complete heart block had the most significant increase in accuracy of diagnose when using the AtriAmp signal ( P < .001, P = .002, P = .010, respectively). Conclusion: Use of the AtriAmp increased provider accuracy and confidence in post-operative rhythm diagnosis when compared to diagnosis using the surface electrograms only.

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Critical arrhythmia in postoperative cardiac children: Recognition and management

Cited by 16 publications

References 22 publications

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

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

β1‐receptor polymorphisms and junctional ectopic tachycardia in children after cardiac surgery

Improvements in Accuracy and Confidence in Rhythm Identification After Cardiac Surgery Using the AtriAmp Signals

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