Arrhythmias in Children in Early Postoperative Period After Cardiac Surgery

Sahu, Manoj Kumar; Das, Anupam; Siddharth, Bharat; Talwar, Sachin; Singh, Sarvesh Pal; Abraham, Atul; Choudhury, Arin

doi:10.1177/2150135117737687

Cited by 40 publications

(44 citation statements)

References 23 publications

(53 reference statements)

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“…Postoperative junctional ectopic tachycardia (JET) is a potential life-threatening arrhythmia occurring after congenital cardiac surgery. [ 1 ] The incidence of JET following congenital cardiac surgery varies widely in literature which can be attributed to the different diagnostic criteria and the great variability in the patients’ characteristics among the published studies. [ 2 ] Incidence of JET is higher when the intervention is close to the atrioventricular node and bundle of Hiss as in tetralogy of Fallot (TOF) and complete atrioventricular canal (AVC) repair.…”

Section: Introductionmentioning

confidence: 99%

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years

Ismail

Arafat

Hamouda

et al. 2018

J Cardiothorac Surg

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BackgroundJunctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age.MethodsFrom 2003 to 2017, 609 patients had Tetralogy of Fallot repair, 322 were included in our study. We excluded patients above 2 years and patients with preoperative arrhythmia. 29.8% of the patients (n = 96) had postoperative JET.ResultsJET patients were younger and had higher preoperative heart rate. Independent predictors of JET were younger age, higher preoperative heart rate, cyanotic spells, non-use of B-blockers and low Mg and Ca (p = 0.011, 0.018, 0.024, 0.001, 0.004 and 0.001; respectively). JET didn’t affect the duration of mechanical ventilation nor hospital stay (p = 0.12 and 0.2 respectively) but prolonged the ICU stay (p = 0.011). JET resolved in 39.5% (n = 38) of patients responding to conventional measures. Amiodarone was used in 31.25% (n = 30) of patients and its use was associated with longer ICU stay (p = 0.017). Ventricular pacing was required in 4 patients (5.2%). Median duration of JET was 30.5 h and 5 patients had recurrent JET episode. Timing of JET onset didn’t affect ICU (p = 0.43) or hospital stay (p = 0.14) however, long duration of JET increased ICU and hospital stay (p = 0.02 and 0.009; respectively).ConclusionJET increases ICU stay after TOF repair. Preoperative B-blockers significantly reduced JET. Patients with preoperative risk factors could benefit from preoperative arrhythmia prophylaxis and aggressive management of postoperative electrolyte disturbance is essential.

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Section: Introductionmentioning

confidence: 99%

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years

Ismail

Arafat

Hamouda

et al. 2018

J Cardiothorac Surg

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“…Частота виникнення ВЕТ широко варіюється в літературі, що можна пояснити різноманітними діагностичними критеріями та значною варіабельністю характеристик пацієнтів в опублікованих дослідженнях. Оперативне втручання та асептичне запалення в зоні атріовентрикулярного вузла та пучка Гіса зумовлює виникнення ВЕТ [1,2].…”

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“…Передопераційна профілактика ВЕТ вважається малоефективною [1,5], тому передопераційна ідентифікація пацієнтів з високим ризиком є вкрай важливою та малодослідженою.…”

Section: вступunclassified

Junctional Ectopic Tachycardia after Complete Repair of Tetralogy of Fallot in Children less than 1 Year

Petrenko

Yakimishin

Boyko

2019

ujcvs

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Junctional ectopic tachycardia (JET) is frequent acceleration of rhythm after complete repair of Tetralogy of Fallot. JET is associated with prolongation of been in the ICU and worsening of the prognosis. The present ways of preventing of JET cannot be routinely applied for all patients, so it needs to identify patients with high risk of JET emergence. Purpose. It needs to analyze cases of JET and identify risk factors for patients requiring Tetralogy of Fallot complete repair. Methods and materials. It was analyzed 81 patients with Tetralogy of Fallot after complete repair from 2014 until 2019 in National Amosov Institute of Cardiovascular Surgery. Results and discussion. Post-operative analysis shows that magnesium and potassium levels in blood were lower in patients with JET than in patients without JET (0.9 ± 0.41 and 1.14 ± 0.43, respectively, p < 0.05). Patients with JET were younger (7.8 ± 1.4 and 9.9 ± 1.6, respectively, p < 0.05), had lower body weight (8.1 ± 1.0 and 9.3 ± 0.9, respectively, p < 0.05) and higher heart rate in the pre-operative period (147.6 ± 11.4 and 124.9 ± 13.9, respectively, p < 0.05). It was found out that pre-operative respiratory cyanotic attacks are independent risk factors for JET. During the work we also found that the administration of beta-blockers in the pre-operative period significantly reduces the JET development (4 (26.6%) and 27 (40.9%) respectively, p <0.05). Conclusion.Younger age, lower body weight, and respiratory cyanotic attacks in the pre-operative period are unadjusted risk factors of the JET development in the early postoperative period. Blood magnesium and potassium concentrations are correlated factors in the JET development. Beta-blockers may be recommended for the prevention of JET in the early post-operative period in patients who have risk factors.

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“…Tachyarrhythmias are found in 6-50% of patients after surgery for congenital heart disease (CHD). [1][2][3][4] Supraventricular tachycardia (SVT) Abbreviations: CHD, congenital heart disease; CPB, cardiopulmonary bypass; DHCA, deep hypothermia and circulatory arrest; ICU, intensive care unit; IQR, interquartile range; LOS, length of stay; STAT, Society of Thoracic Surgeons-European Association for Cardio-thoracic Surgery; SVT, supraventricular tachycardia.…”

Section: Introductionmentioning

confidence: 99%

“…Younger age, longer bypass and cross-clamp times, deep hypothermia with circulatory arrest, and higher Aristotle risk scores are associated with an increased risk of tachyarrhythmia. [1][2][3][4] In patients with single ventricle physiology undergoing stage 1 procedures, the incidence of arrhythmia is as high as 20-50%. [5][6][7][8] Arrhythmias have been shown to be associated with significant morbidity in patients after a stage 1 procedure, including longer time to extubation and total hospital length of stay (LOS).…”

Section: Introductionmentioning

confidence: 99%

Value of provocative electrophysiology testing in the management of pediatric patients after congenital heart surgery

Dionne

Kheir

Triedman

et al. 2020

Pacing Clinical Electrophis

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Objective To determine the impact of provocative electrophysiology testing in postoperative congenital heart disease (CHD) patients on the management of supraventricular tachycardia (SVT) and clinical outcomes. Methods This is a retrospective study including patients <18 years of age with surgery for CHD who had postoperative SVT between 2006 and 2017. Postoperative outcomes were compared between patients with and without postoperative electrophysiology testing using the Wilcoxon rank sum test, Fisher's exact test, Kaplan‐Meier method with the log‐rank test, and Cox proportional hazard model. Results From 341 patients who had SVT after surgery for CHD, 65 (19%) had postoperative electrophysiology testing. There was no significant difference in baseline patient characteristics or surgical complexity between patients with and without electrophysiology testing. Patients with inducible SVT on electrophysiology testing were more likely to have recurrence of SVT prior to hospital discharge with an odds ratio 4.0 (95% confidence interval 1.3, 12.0). Patients who underwent postoperative electrophysiology testing had shorter intensive care unit (12 [6, 20] vs 16 [9, 32] days, HR 2.1 [95% CI 1.6, 2.8], P < .001) and hospital (25 [13, 38] vs 31 [18, 54] days, HR 1.8 [95% CI 1.4, 2.4], P < .001) length of stay. Conclusion Postoperative electrophysiology testing was associated with improved postoperative outcomes, likely related to the ability to predict recurrence of arrhythmia and tailored antiarrhythmic management.

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Arrhythmias in Children in Early Postoperative Period After Cardiac Surgery

Cited by 40 publications

References 23 publications

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years

Junctional Ectopic Tachycardia after Complete Repair of Tetralogy of Fallot in Children less than 1 Year

Value of provocative electrophysiology testing in the management of pediatric patients after congenital heart surgery

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