Early postoperative arrhythmias in patients undergoing congenital heart surgery

Abstract

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.

Risk factor analysis and risk prediction model of arrhythmia after Da Vinci robotic cardiac surgery

“…Arrhythmia after cardiac surgery is one of the common and serious postoperative complications, with an incidence of 7.5% to 48% [20][21][22]. Most arrhythmic events occur in the early postoperative period [23], due to direct damage or manipulation of the cardiac conduction system during surgery, or due to myocardial edema and in ammation near the conduction system. High postoperative catecholamine levels and electrolyte disturbances are also possible causes, and prolonged myocardial dysfunction due to pressure or volume overload also makes these patients particularly vulnerable to arrhythmias [24].…”

“…Arrhythmias after cardiac surgery are mostly atrial brillation [25], and Echahidi et al showed that the overall incidence of arrhythmias after cardiac surgery is 60.2%, the most common type is atrial brillation (35.0%), and atrial brillation after valve surgery is about 40%, followed by conduction block (5.3%) [26].In this study, atrial brillation accounted for 73.91% of total arrhythmia, new atrial brillation occurred in 40.9% after valve surgery, and one patient developed sinus arrest and junctional rhythm after surgery and was successfully discharged through medical pacemaker treatment.Many studies have now shown that advanced age, race, gender, history of myocardial infarction, obesity, metabolic syndrome, and left atrial diameter 45 mm are considered risk factors for postoperative arrhythmias [27][28][29].Age, operation time, CPB time, and aortic cross-clamp time were independent risk factors for postoperative arrhythmia [23,30].This study showed that age, weight, BMI, diabetes, NYHA class, LAD, LVDs, RVDs, TBIL, DBIL, UA, RDW, operation time, CPB time, aortic cross-clamp time, and operation type were associated with arrhythmia after robotic heart surgery, and further multivariate regression analysis indicated that preoperative DBIL level and aortic cross-clamp time were independent risk factors.Preoperative DBIL levels re ect the ability of liver cells to transform indirect bilirubin in cardiac patients, and some patients with heart disease have poor preoperative cardiac function, resulting in hepatic congestion further leading to hepatocyte injury, and such patients have poor preoperative cardiac function, which may lead to postoperative arrhythmia.It has been con rmed that preoperative DBIL level is an independent predictor of atrial brillation after cardiac surgery [31], and bilirubin level may be associated with recurrence after cardiac atrial brillation ablation [32].The relationship between atrial diameter and postoperative atrial brillation has been demonstrated [33], but this study found signi cant differences in preoperative atrioventricular structure between patients with and without arrhythmia, but did not con rm its independent risk factors.Aortic crossclamp time is closely related to myocardial ischemia-reperfusion injury, and a large number of studies have shown that it is an independent risk factor for a variety of postoperative complications.This study showed that aortic crossclamp time was an independent risk factor for arrhythmia after robotic cardiac surgery, which was consistent with previous studies. Accurate intraoperative operation shortened myocardial ischemia time, which was a key factor to reduce postoperative arrhythmia.…”

Risk factor analysis and risk prediction model of arrhythmia after Da Vinci robotic cardiac surgery

“…Arrhythmia after cardiac surgery is one of the common and serious postoperative complications, with an incidence of 7.5-48% [20][21][22]. Most arrhythmic events occur in the early postoperative period [23], due to direct damage or manipulation of the cardiac conduction system during surgery, or due to myocardial edema and in ammation near the conduction system. High postoperative catecholamine levels and electrolyte disturbances are also possible causes, and prolonged myocardial dysfunction due to pressure or volume overload also makes these patients particularly vulnerable to arrhythmias [24].…”

“…, and Echahidi et al showed that the overall incidence of arrhythmias after cardiac surgery is 60.2%, the most common type is atrial brillation (35.0%), and atrial brillation after valve surgery is about 40%, followed by conduction block (5.3%)[26].In this study, atrial brillation accounted for 73.91% of total arrhythmia, new atrial brillation occurred in 40.9% after valve surgery, and one patient developed sinus arrest and junctional rhythm after surgery and was successfully discharged through medical pacemaker treatment.Many studies have now shown that advanced age, race, gender, history of myocardial infarction, obesity, metabolic syndrome, and left atrial diameter 45 mm are considered risk factors for postoperative arrhythmias[27- 29].Age, operation time, CPB time, and aortic cross-clamp time were independent risk factors for postoperative arrhythmia[23,30].This study showed that age, weight, BMI, diabetes, NYHA class, LAD, LVDs, RVDs, TBIL, DBIL, UA, RDW, operation time, CPB time, aortic cross-clamp time, and operation type were associated with arrhythmia after robotic heart surgery, and further multivariate regression analysis indicated that preoperative DBIL level and aortic cross-clamp time were independent risk factors.Preoperative DBIL levels re ect the ability of liver cells to transform indirect bilirubin in cardiac patients, and some patients with heart disease have poor preoperative cardiac function,…”

Risk factors of early postoperative cardiac arrhythmia after pediatric cardiac surgery

“…14 Furthermore, a cohort study in 2021 showed that the frequency and diagnosis of arrhythmias might differ depending on the type of cardiac procedure. 16 A study in Switzerland found that various variables could cause or aggravate postoperative arrhythmias. These variables included pre-existing myocardial compromise due to cardiac defects, complex procedures with extensive scars and suture lines, consequences of myocardial ischemia, postoperative electrolyte disturbances, and increased adrenergic tone or catecholamine stimulation.…”