The Prevalence and Risk Factors of Early Arrhythmias Following Pediatric Open Heart Surgery in Egyptian Children

Abstract

AIM:This study aimed to assess the prevalence of early postoperative arrhythmias after cardiac operation in the pediatric population, and to analyse possible risk factors.MATERIAL AND METHODS:Cross-sectional study included 30 postoperative patients, with age range four up to 144 months. They were selected from those admitted to the Cardiology Unit in the Pediatric department of Ain Shams University hospitals, after undergoing cardiopulmonary bypass (CPB) surgery for correction of congenital cardiac defects. All patients had preoperative sinus rhythm and normal preoperative electrolytes levels. All patients’ records about age, weight, type of surgery, intraoperative arrhythmias, cardiopulmonary bypass time, ischemic time and use of inotropic drugs were taken before they were admitted to the specialised pediatric post-surgery intensive care unit (ICU).RESULTS:Arrhythmia was documented in 15 out of 30 patients (50%). Statistically significant difference between the arrhythmic and non-arrhythmic group were recorded in relation to the age of operation (23 vs 33 months), weight (12 vs. 17 kg), ischemic time (74.5 vs. 54 min), cardiopulmonary bypass time (125.5 vs. 93.5min), inotrope use (1.6 vs. 1.16) and postoperative ICU stay (5.8 vs. 2.7 days), P<0.05.CONCLUSION:Early postoperative arrhythmias following surgery for congenital heart disease are relatively frequent in children (50%). Younger age, lower body weight, longer ischemic time and bypass time, and more inotrope use are all risk factors for postoperative arrhythmias and lead to increase the hospital stay.

Prevalence and risk factors analysis of early postoperative arrhythmia after congenital heart surgery in pediatric patients

“…9 The difference results can also be caused by the measurement method, according to Grosse Wortman, measuring data with Holter monitoring, cause the diagnosis of arrhythmia to be more sensitive than studies using bedside monitoring, so it showed the highest prevalence compared to previous studies. 15 Complete heart block (CHB) is the most common type of arrhythmia after cardiac surgery in this study, with prevalence rate of five patients This is consistent with previous studies, CHB is the most common complication after congenital heart defect surgery, [2][3][4]7,9 and it occurred 1%-6% after congenital heart defects surgery. 16 Atrioventricular node is found in a specific area called the triangle of Koch within the bottom part of the right atrium.…”

“…age of a child undergoing surgical procedures, the higher the risk of early postoperative arrhythmia. 4,9 Based on gender, the frequency of females with congenital heart defects in this study dominated at 48 patients (52.2%), which is consistent with previous research findings, 7,18 And it is not consistent with other studies that show males dominate congenital heart defects. 2,3,9 Despite the difference results from previous research, based on statistical tests, there was no significant difference between gender and the rate of early postoperative arrhythmia in congenital heart surgery, which is consistent with the findings of this study.…”

“…5 This study showed that longer durations of CPB, AoX time, ischemia time, and lower potassium levels increase the risk of early postoperative arrhythmia, and based on multivariate linear regression analysis, CPB time and potassium levels, indicating both were found to be independent risk factor for patients with congenital heart defects who underwent cardiac surgery. This is related to the complexity of heart surgery, 4,21 inflammation caused by the use of CPB, 2,11,22 and the use of cardioplegia, which leads to electromechanical arrest and potentially causes arrhythmia. 23 Additionally, ultrafiltration after CPB was performed on all patients as a standard procedure in our institution.…”

“…The prevalence of postoperative arrhythmias after cardiac surgery for congenital heart defects is 7.3%–48%, 2 with a mortality rate of 9.1% 3 . A number recent studies shown the most type of arrhythmia observed was Junctional Ectopic Tachycardia 2–4 . Several factors contribute to the occurrence of cardiac arrhythmias after cardiac surgery, including patient‐related risk factors and surgery‐related risk factors 5 .…”

“…Several factors contribute to the occurrence of cardiac arrhythmias after cardiac surgery, including patient‐related risk factors and surgery‐related risk factors 5 . Patient‐related risk factors include age, 4,5 abnormalities of the heart anatomy 2,4,5 and comorbidities. Surgery‐related risk factors include trauma, postsurgical inflammation, 2,5 hemodynamic stress, 5,6 postsurgical myocardial ischemia, 4,5,7 perioperative drugs, and electrolyte disturbances 2,4,5,7 …”