Arrhythmia in early post cardiac surgery in pediatrics: Siriraj experience.
OBJECTIVE
To determine the incidence, risk factors and outcome of early postoperative arrhythmias in pediatric patients with congenital heart disease.


METHODS
A prospective study was conducted in every pediatric patient who consecutively underwent open-heart surgery at Siriraj Hospital from January 1st to December 31st, 2006. The collected data were demographic data, diagnosis, pre-operative arrhythmia, cardiac surgical data and continuous electrocardiographic monitoring data throughout the post operative intensive care period.


RESULTS
A total of 191 pediatric patients underwent cardiac surgery. Forty-five cases (23.5%) developed early post operative cardiac arrhythmias i.e. junctional ectopic tachycardia 18 cases (40%), heart block 7 cases (15.6%), supraventricular tachycardia 2 cases (4.4%). Cardiac arrhythmia occurred mostly within 24 hours after the operation. Patients with single ventricle physiology repaired developed the highest incidence of acute post operative arrhythmia (36.4%). Longer, cardiopulmonary bypass time- and redo-operation were the risk factors. Thirty-nine cases were treated with medications, 7 cases with temporary pacing, and 1 case with electrical cardioversion. Four patients needed long-term anti-arrhythmic agents. Cardiac arrhythmia played role in the causes of death in 2 cases (1.1% of total cases).


CONCLUSIONS
Post operative arrhythmias remained common and important complications of pediatric open-heart surgery. Long cardiopulmonary bypass time and redo-operation were risk factors for early post operative arrhythmia.
Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Kanoknaphat
K
Chaiyarak
Jarupim
J
Soongswang
Kritvikrom
K
Durongpisitkul
Duangmanee
D
Laohaprasitiporn
Prakul
P
Chanthong
Apichart
A
Nana
Somchai
S
Sriyodcharti
Thaworn
T
Subtaweesin
Ungkab
U
Prakanrattana
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D054537:Atrioventricular Block / Q000209:etiology; D002648:Child; D002669:Child Welfare; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D013613:Tachycardia, Ectopic Junctional / Q000209:etiology; D013785:Thailand; D013903:Thoracic Surgery; D013997:Time Factors