title: Arrhythmias Following Comprehensive Stage II Surgical Palliation in Single Ventricle Patients.
abstract: Post-operative arrhythmias are common in pediatric patients following cardiac surgery. Following hybrid palliation in single ventricle patients, a comprehensive stage II palliation is performed. The incidence of arrhythmias in patients following comprehensive stage II palliation is unknown. The purpose of this study is to determine the incidence of arrhythmias following comprehensive stage II palliation. A single-center retrospective chart review was performed on all single ventricle patients undergoing a comprehensive stage II palliation from January 2010 to May 2014. Pre-operative, operative, and post-operative data were collected. A clinically significant arrhythmia was defined as an arrhythmia which led to cardiopulmonary resuscitation or required treatment with either pacing or antiarrhythmic medication. Statistical analysis was performed with Wilcoxon rank-sum test and Fisher's exact test with p < 0.05 significant. Forty-eight single ventricle patients were reviewed (32 hypoplastic left heart syndrome, 16 other single ventricle variants). Age at surgery was 185 ± 56 days. Cardiopulmonary bypass time was 259 ± 45 min. Average vasoactive-inotropic score was 5.97 ± 7.58. Six patients (12.5 %) had clinically significant arrhythmias: four sinus bradycardia, one 2:1 atrioventricular block, and one slow junctional rhythm. No tachyarrhythmias were documented for this patient population. Presence of arrhythmia was associated with elevated lactate (p = 0.04) and cardiac arrest (p = 0.002). Following comprehensive stage II palliation, single ventricle patients are at low risk for development of tachyarrhythmias. The most frequent arrhythmia seen in these patients was sinus bradycardia associated with respiratory compromise.
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. carolyn.wilhelm@nationwidechildrens.org.
authors.forename: Carolyn M
authors.identifier: http://orcid.org/0000-0002-9695-3150
authors.initials: CM
authors.lastname: Wilhelm
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Paulus
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Cua
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Kertesz
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Cheatham
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.affiliation: The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Fernandez
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D015994:Incidence; D007223:Infant; D008297:Male; D009820:Ohio; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Arrhythmia; Hypoplastic left heart syndrome; Palliation; Single ventricle