Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period

Rękawek, Joanna; Kansy, Andrzej; Miszczak-Knecht, Maria; Manowska, Małgorzata; Bieganowska, Katarzyna; Brzezińska-Paszke, Monika; Szymaniak, E; Turska−Kmieć, Anna; Maruszewski, Przemysław; Burczyński, Piotr; Kawalec, Wanda

doi:10.1016/j.jtcvs.2006.12.011

Cited by 120 publications

(117 citation statements)

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“…However, the wide spectrum of congenital heart diseases and varying surgical approaches to manage them create endless possibilities for the type and outlook of these arrhythmias. [4][5][6][7] The incidence of acute postoperative arrhythmias ranges from 7.3% to 48%. [4][5][6]8,9 Pathophysiological causes of early postoperative arrhythmias include direct surgical injuries such as myocardial incision, cannulation, sutures close to the conduction system, and acute changes in intracardiac pressure caused by volume and pressure overload.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6]8,9 Pathophysiological causes of early postoperative arrhythmias include direct surgical injuries such as myocardial incision, cannulation, sutures close to the conduction system, and acute changes in intracardiac pressure caused by volume and pressure overload. [1][2][3][4][5][6][7][8][9][10] Furthermore, cardiopulmonary bypass (CPB) with ischemia-reperfusion and related cellular biochemical effects as well as medical interventions such as electrolyte shifts and catecholamine administration may affect the stability of the cellular membrane and result in increased myocardial irritability and automaticity. 11,12 At the All India Institute of Medical Sciences, nearly 50 open heart surgeries are performed every week for congenital heart disorders of all types.…”

Section: Introductionmentioning

confidence: 99%

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Early postoperative arrhythmias after pediatric cardiac surgery

Talwar

Patel

Juneja

et al. 2015

Asian Cardiovasc Thorac Ann

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early postoperative arrhythmias after pediatric cardiac surgery

Talwar

Patel

Juneja

et al. 2015

Asian Cardiovasc Thorac Ann

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“…Rekawek J et al also found a similar incidence with 21 cases of JET among 402 children operated for congenital heart disease [8]. 8% incidence of JET among 336 cases were noted by Batra AS et al [9].…”

mentioning

confidence: 61%

Junctional Ectopic Tachycardia

Wren

2011

Concise Guide to Pediatric Arrhythmias

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Junctional ectopic tachycardia (JET) often occurs in the setting of surgery for congenital heart disease [1]. A congenital variety of JET not related to any surgery has also been described [2]. While post surgical JET has a mortality upto 14% [1], congenital JET has a mortality upto 34% [3]. A case of JET associated with myocarditis, has also been reported [4]. Electrocardiographic diagnosis of JET is made by the presence of AV dissociation in a narrow QRS complex tachycardia at a rate of 170 to 260 beats per minute and JET usually occurs within the first 24 to 48 hours of surgery [5]. Younger children tend to have faster and incessant JET [6]. JET in the fetus can be diagnosed based on AV dissociation noted in superior vena cava/ascending aorta Doppler flow recordings [7].Mildh et al identified 51 patients with JET among a group of 1001 children undergoing open heart surgery over a 5 year period, an incidence of about 5% [1]. Rekawek J et al also found a similar incidence with 21 cases of JET among 402 children operated for congenital heart disease [8]. 8% incidence of JET among 336 cases were noted by Batra AS et al [9]. Andreasen JB et al reported an incidence of 10.2% of JET among 874 children who underewent corrective cardiac surgery [10].In case of post operative JET, longer cardiopulmonary bypass time, higher body temperature and higher levels of postoperative troponin T or creatine kinase and high inotropic requirement were associated with JET. These patients also needed longer ventilatory support and intensive care, compared to controls matched for the same type of surgery [1,[9][10][11]. Age less than 1 month, history of cardiac failure and an Aristotle score more than 4 were also associated with JET [12].Intravenous infusion of cold saline in addition to surface cooling, to achieve a core temperature of 32-34 ºC was evaluated in a pilot study for the management of post operative JET in 10 patients recently [13]. The median heart rate decreased from 187 beats per minute to 158 beats per minute. They could achieve AV synchrony in all patients, either by restoration of sinus rhythm or successful atrial pacing. Usually atrial pacing will not affect JET, as is demonstated in the case report by Arshi et al [14] in this issue of the journal. Occasionally, extracorporeal mechanical oxygenation is needed to support the circulation until the arrhythmia gets controlled [15].Magnesium supplementation during cardiopulmonary bypass decreased the incidence of JET in a randomized, double blind controlled trial involving 99 children who underwent pediatric cardiac surgery [12].

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“…JET occurred in 22% of Tetralogy of Fallot (TOF) repairs, 10% of atrio-ventricular septal defect repairs, and 3.7% of VSD repairs (Dodge-Khatami et al 2002). Predictors of post-operative JET were younger age (Hoffman et al 2002), lower body weight (Rekawek et al 2007), resection of muscle bundles, higher bypass temperatures, and relief of right ventricular outflow tract obstruction through the right atrium (Dodge-Khatami et al 2002). 7.1.3 Mechanism: Although the mechanism of JET is unclear, abnormal (enhanced) automaticity of the junction has been put forth.…”

Section: Junctional Tachy-arrhythmiasmentioning

confidence: 99%

Arrhythmias in Children and Young Adults

Singh¹

2012

Advances in Electrocardiograms - Clinical Applications

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Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period

Cited by 120 publications

References 11 publications

Early postoperative arrhythmias after pediatric cardiac surgery

Early postoperative arrhythmias after pediatric cardiac surgery

Junctional Ectopic Tachycardia

Arrhythmias in Children and Young Adults

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