The Journal of Thoracic and Cardiovascular Surgery
Volume 133, Issue 4 , Pages 900-904, April 2007

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

  • Joanna Rękawek, MD

      Affiliations

    • Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
    • Corresponding Author InformationAddress for reprints: Joanna Rękawek, MD, Department of Cardiology, Children’s Memorial Health Institute, Al. Dzieci Polskich 20 04-830 Warsaw, Poland.
    • ,
  • Andrzej Kansy, MD

      Affiliations

    • Department of Cardiac Surgery, Children’s Memorial Health Institute, Warsaw, Poland
    • ,
  • Maria Miszczak-Knecht, MD

      Affiliations

    • Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
    • ,
  • Małgorzata Manowska, MD

      Affiliations

    • Department of Anesthesiology, Children’s Memorial Health Institute, Warsaw, Poland.
    • ,
  • Katarzyna Bieganowska, MD, PhD

      Affiliations

    • Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
    • ,
  • Monika Brzezinska-Paszke, MD

      Affiliations

    • Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
    • ,
  • Elżbieta Szymaniak, MD

      Affiliations

    • Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
    • ,
  • Anna Turska-Kmieć, MD

      Affiliations

    • Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
    • ,
  • Przemysław Maruszewski, MD

      Affiliations

    • Department of Cardiac Surgery, Children’s Memorial Health Institute, Warsaw, Poland
    • ,
  • Piotr Burczyński, MD, PhD

      Affiliations

    • Department of Cardiac Surgery, Children’s Memorial Health Institute, Warsaw, Poland
    • ,
  • Wanda Kawalec, MD, PhD

      Affiliations

    • Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland

Received 29 July 2006; received in revised form 28 November 2006; accepted 13 December 2006.

Objective

Early postoperative arrhythmias are a recognized complication of pediatric cardiac surgery.

Methods

Diagnosis and treatment of early postoperative arrhythmias were prospectively analyzed in 402 consecutive patients aged 1 day to 18 years (mean 29.5 months) who underwent operation between January and December 2005 at our institute. All children were admitted to the intensive care unit, and continuous electrocardiogram monitoring was performed. Risk factors, such as age, weight, Aristotle Basic Score, cardiopulmonary bypass time, aortic crossclamp time, and use of deep hypothermia and circulatory arrest, were compared. Statistical analysis using the Student t test, Mann–Whitney U test, or Fisher exact test was performed. Multivariate stepwise logistic regression was used to assess the risk factors of postoperative arrhythmias.

Results

Arrhythmias occurred in 57 of 402 patients (14.2%). The most common types of arrhythmia were junctional ectopic tachycardia (21), supraventricular tachycardia (15), and arteriovenous block (6). Risk factors for arrhythmias, such as lower age (P = .0041⁎), lower body weight (P = .000001⁎), higher Aristotle Basic Score (P = .000001⁎), longer cardiopulmonary bypass time (P = .000001⁎), aortic crossclamp time (P = .000001⁎), and use of deep hypothermia and circulatory arrest (P = .0188⁎), were identified in a univariate analysis. In the multivariate stepwise logistic regression, only higher Aristotle Basic Score was statistically significant (P = .000003⁎) compared with weight (P = .62) and age (P = .40); in the cardiopulmonary bypass group, only longer aortic crossclamp time was statistically significant (P = .007⁎).

Conclusion

Lower age, lower body weight, higher Aristotle Basic Score, longer cardiopulmonary bypass time, aortic crossclamp time, and use of deep hypothermia and circulatory arrest are the risk factors for postoperative arrhythmias. Junctional ectopic tachycardia and supraventricular tachycardia were the most common postoperative arrhythmias.

CTSNet classification: 20, 21, 24

Abbreviations and Acronyms: AV, atrioventricular, CI, confidence interval, CPB, cardiopulmonary bypass, DHCA, deep hypothermia and circulatory arrest, ICU, intensive care unit, JET, junctional ectopic tachycardia, SD, standard deviation, SVT, supraventricular tachycardia

 

 The study was approved by the Ethical Committee of the Children’s Memorial Health Institute and supported by an internal grant of the Children’s Memorial Health Institute (Grant No. 84/05).

PII: S0022-5223(06)02307-5

doi:10.1016/j.jtcvs.2006.12.011

The Journal of Thoracic and Cardiovascular Surgery
Volume 133, Issue 4 , Pages 900-904, April 2007

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