Early arrhythmia burden in pediatric cardiac surgery fast-track candidates: Analysis of incidence and risk factors

Abstract

An increasing number of pediatric heart centers are utilizing early extubation protocols to “fast-track” patients after congenital heart surgery. Early postoperative arrhythmias are an important recognized complication of pediatric heart surgery, but the arrhythmia burden among candidates for extubation immediately after bypass surgery is unknown. This study evaluated the incidence and risk factors associated with postoperative arrhythmias in surgical fast-track candidates.Postoperative rhythm status and potential perioperative risk factors were retrospectively analyzed in all patients undergoing surgery for congenital heart disease from 2012 to 2014 who were considered early extubation candidates. Overall, 199 operations in 196 individual patients (30 days–19 years) were included. The overall incidence of arrhythmias was 9% (18/199). The most common arrhythmia was junctional ectopic tachycardia (5%; 10/199), followed by atrial tachycardia (1.5%; 3/199) and complete heart block (1.5%; 3/199). Two patients with junctional ectopic tachycardia had permanent complete heart block. Compared to patients with no arrhythmias, patients with arrhythmias were more likely to be younger (0.5 vs. 2.4 years, U = 783, p < 0.001) and to weigh less (6.0 vs.12 kg, U = 853, p < 0.005). Surgical repairs with the highest incidence of arrhythmia were tetralogy of Fallot-type (6/18, 33%; p = 0.017), followed by repair of atrioventricular canal (5/18, 28%, p = 0.022) and ventricular septal defect repair (4/18, 22%, p = 0.758). In an unadjusted analysis, younger patient age, STAT category 4 procedures, and increasing cross-clamp time were significantly associated with the occurrence of arrhythmias. Amiodarone and procainamide were the most common drugs used for junctional ectopic tachycardia and atrial tachycardia. There were no deaths related to postoperative arrhythmias.Early postoperative arrhythmias are common among fast-track candidates. Patient age and operation complexity may predict risk of early arrhythmia. These data provide important information to help guide programmatic and clinical decision-making when contemplating fast tracking children after congenital heart surgery.