Perioperative atrial tachycardia is associated with increased mortality in infants undergoing cardiac surgery.
OBJECTIVE
Few data are available on the frequency or importance of perioperative atrial tachycardia in infants. We hypothesized that atrial tachycardia in infants undergoing cardiac surgery is not rare and is associated with increased morbidity and mortality.


METHODS
From 2007 through 2010, 777 infants (median age, 1.8 months; interquartile range, 0.33-5.73) underwent cardiac surgery. Their medical records were reviewed for atrial tachycardia during the perioperative period.


RESULTS
Of the 777 patients, 64 (8.2%) developed atrial tachycardia. The independent risk factors for developing atrial tachycardia included surgical age 6 months or younger (odds ratio, 4.4; 95% confidence interval, 1.1-19.15), use of 3 or more inotropes (odds ratio, 2.9; 95% confidence interval, 1.4-6.2), and heterotaxy syndrome (odds ratio, 2.9; 95% confidence interval, 1.1-7.4). All-cause mortality in the atrial tachycardia group was increased (21.9% vs 7.2%, P<.001) during a median follow-up period of 14.6 months (interquartile range, 6.8-24.6), and atrial tachycardia was independently associated with decreased survival (hazard ratio, 1.9; 95% confidence interval, 1.1-3.8). Infants with perioperative atrial tachycardia had a longer hospital length of stay (32 vs 17 days, P<.001) and duration of inotrope use (10.5 vs 3.0 days, P<.001). A total of 57 patients received antiarrhythmic therapy, with propranolol the most common (n=31). Among the survivors, 48 patients received outpatient antiarrhythmic therapy, which was successfully discontinued in 23 patients at a median duration of 14 months (interquartile range, 5.7-18.6) without recurrence.


CONCLUSIONS
Atrial tachycardia is common in infants undergoing cardiac surgery and is independently associated with decreased survival. Among survivors, antiarrhythmic agents successfully controlled atrial tachycardia in most patients with a low recurrence risk after discontinuation.
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, and Department of Pharmacy, Texas Children's Hospital, Houston, TX 77030, USA. shamszad@bcm.edu
Pirouz
P
Shamszad
Antonio G
AG
Cabrera
Jeffrey J
JJ
Kim
Brady S
BS
Moffett
Daniel E
DE
Graves
Jeffrey S
JS
Heinle
Joseph W
JW
Rossano
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000453:epidemiology / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D059446:Heterotaxy Syndrome / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D059035:Perioperative Period; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000453:epidemiology*
D000889:Anti-Arrhythmia Agents