Prevalence of and risk factors for perioperative arrhythmias in neonates and children after cardiopulmonary bypass: continuous holter monitoring before and for three days after surgery

J Cardiothorac Surg. 2010 Oct 18:5:85. doi: 10.1186/1749-8090-5-85.

Abstract

Background: A comprehensive evaluation of postoperative arrhythmias following surgery for congenital heart disease by continuous Holter monitoring has not been carried out. We aimed, firstly, to establish the time course of pre- and early postoperative arrhythmias by beat-to-beat analysis following cardiopulmonary bypass and, secondly, to examine which surgical procedures present risk factors for specific arrhythmias.

Methods: 494 consecutive patients, including 96 neonates, were studied with serial 24-hour Holter electrocardiograms before as well as uninterruptedly during the first 72 hours after surgery and prior to discharge.

Results: Within 24 hours of surgery 59% of the neonates and 79% of the older children developed arrhythmias. Junctional ectopic tachycardia occurred in 9% of neonates and 5% of non-neonates and ventricular tachycardia in 3% and 15%, respectively.For neonates, male sex and longer cross-clamping time independently increased the risk for arrhythmias (odds ratios 2.83 and 1.96/minute, respectively). Ventricular septal defect repair was a strong risk factor for junctional ectopic tachycardia in neonates and in older children (odds ratios 18.8 and 3.69, respectively). For infants and children, older age (odds ratio 1.01/month) and closure of atrial septal defects (odds ratio 2.68) predisposed to arrhythmias of any type.

Conclusions: We present the largest cohort of neonates, infants and children that has been prospectively studied for the occurrence of arrhythmias after cardiac surgery. Postoperative arrhythmias are a frequent and transient phenomenon after cardiopulmonary bypass, provoked both by mechanical irritation of the conduction system and by humoral factors.

MeSH terms

  • Adolescent
  • Arrhythmias, Cardiac / diagnosis*
  • Arrhythmias, Cardiac / epidemiology*
  • Arrhythmias, Cardiac / etiology*
  • Cardiopulmonary Bypass*
  • Child
  • Child, Preschool
  • Electrocardiography, Ambulatory*
  • Female
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology*
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Statistics, Nonparametric