Abstract 10386: Clinical and Genetic Risk Factors for Post-Operative Atrial Tachycardia After Congenital Heart Surgery in Infants

Abstract

Introduction: Atrial tachycardia (AT) after infant congenital heart disease (CHD) surgery has been associated with increased mortality. Common genetic variants in PITX2 (rs2200733) and IL6 (rs1800795) have been associated with post-operative AT in adults, but have not been studied in infants after CHD surgery. Hypothesis: Genetic variants in PITX2 and IL6 are associated with post-operative AT in infants with CHD. Methods: Children less than 1 year of age undergoing their first CHD surgery at our center between 9/2007 and 3/2014 who consented to the study were included. Subjects provided a DNA sample and had repeated daily assessment of telemetry with documentation of all arrhythmias and clinical variables. Genotyping was performed in the Vanderbilt genomics core lab using the TaqMan PCR Core Reagent Kit. Children with and without AT were compared using chi-square or unpaired t-test as appropriate. Results: Of 923 enrolled infants, 141 had post-operative AT (15.3%), 79 of who required treatment (8.6%). AT was associated with increased mortality (12.1% mortality with AT; vs. 5.5% no AT, P = 0.004), longer hospital stay (mean of 49 days with AT; vs. 23 days no AT, P < 0.0001), intensive care unit (ICU) stay (mean of 34 days with AT; vs.13 days no AT, P < 0.0001), and mechanical ventilation duration (mean of 22 days with AT; vs. 8 days no AT, P < 0.0001). Age, epinephrine use, milrinone use, bypass time, cross-clamp time, lactate, and number of pump runs were associated with AT and AT requiring treatment. PITX2 and IL6 genotypes were not significantly associated with AT or AT requiring treatment. Conclusions: AT is associated with increased mortality and longer hospital stay, ICU stay, and mechanical ventilation duration. Numerous operative factors contribute to AT after infant CHD surgery. PITX2 and IL6 genetic variants were not found to be significantly associated with post-operative AT in infants undergoing CHD surgery in our study.