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Abstract
Background: Anesthesia is essential to facilitate the majority of pediatric electrophysiology studies (EPS); however, a risk of an arrhythmia exists during its induction. The purpose of this study was to determine the incidence of arrhythmia during anesthesia induction in pediatric EPS. Methods: IRB approved retrospective review of pediatric EPS from 1/99 to 1/14. Inclusion criteria: Age ≤ 21 years and comprehensive EPS under general anesthesia. Data collected: demographics, EPS results, and anesthesia records. Patients were grouped based upon route of anesthesia administration: Intravenous (IV) agents (propofol, ketamine, and kentanyl) and Inhalational (IH) agents (sevoflurane, isoflurane and desflurane). Sinus Tachycardia (STACH) was defined as variable heart rates of >140 and <180 beats per minute (bpm) originating from sino-atrial node with a duration of ≥5 minutes. Supraventricular Tachycardia (SVT) was defined as an abnormal heart rhythm arising due to abnormal electrical activity of the heart, originating proximal to the bundle of His, with sustained rates ≥ 180 bpm. Results: Inclusion criteria were met by 378 patients, 57% male, median age 14 ± 4 years, with IV induction utilized in 275 (72%) patients. During induction, 39 (10%) developed tachycardia: 38 STACH and 1 SVT. STACH was more common with IH anesthesia when compared to IV (p<0.0001). Patients with Wolff-Parkinson-White (WPW), irrespective of anesthesia type, had twice the risk of developing STACH, 17/114 vs. 21/264 of others (p = 0.02). Conclusion: Sinus Tachycardia occurred in 10% of pediatric electrophysiology cases performed under anesthesia. It was seen more frequently when IH agents were used compared to IV. Patients with WPW have double the risk of developing sinus tachycardia during anesthesia induction when compared to patients with other forms of SVT.
Highlights
An Electrophysiology study (EP study) is a specialized intra-cardiac procedure utilizing catheters to evaluate the cardiac conduction system
Sinus Tachycardia occurred in 10% of pediatric electrophysiology cases performed under anesthesia
Patients with WPW have double the risk of developing sinus tachycardia during anesthesia induction when compared to patients with other forms of Supraventricular Tachycardia (SVT)
Summary
An Electrophysiology study (EP study) is a specialized intra-cardiac procedure utilizing catheters to evaluate the cardiac conduction system. Due to the highly technical nature of these studies and the fact that they are often performed on children and adolescents, it is important to perform these procedures while the patient is comfortable and/or asleep. These studies can be performed under sedation only in older adolescents if the patient is cooperative. The cardiovascular side effects associated with the utilization of anesthetic agents include cardiac arrest, desaturation, hypotension, bradycardia/tachycardia, and changes in cardiomyocyte repolarization time (QT prolongation) resulting in arrhythmias [1,2,3,4,5,6,7,8].
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