Risk Factors for Early Post-Operative Arrhythmias in Children Undergoing  Congenital Heart Surgeries

Abstract

Objective: To determine the risk factors for early post-operative arrhythmias in children undergoing congenital heart surgeries at a tertiary care hospital. Study Design: Prospective longitudinal study. Place and Duration of Study: National Institute of Cardiovascular Disease, Karachi Pakistan, from Jan to Jul 2020. Methodology: We included 143 patients of both genders undergoing open heart surgery for congenital heart diseases. We noted all patients' pre-operative, intra-operative, and post-operative clinical characteristics. Patients were monitored in the pediatric cardiac intensive care unit. We analyzed the development of postoperative arrhythmias and the factors associated with them. Results: In 143 patients, the mean age at the time of surgery was 7.52±6.0 years. There were 83(58.0%) male patients. Tetralogy of Fallot was the most common type of congenital heart disease noted in 57(39.0%) patients. The mean cardiopulmonary bypass time was 83.9±25.5 minutes, while the mean aortic cross-clamp time was 58.1±21.9 minutes. Post-operatively, arrhythmia was observed in 39(27.3%) children. Intra-operative arrhythmias (p<0.001), prolonged cardiopulmonary bypass time (p=0.008), prolonged cross-clamp time (p<0.001), higher inotropic score (p<0.001) and lower post-operative left ventricular ejection fraction (p=0.001) were significantly associated with arrhythmias. Conclusion: The post-operative arrhythmias among patients undergoing congenital heart surgeries was high. Intra-operative arrhythmias, prolonged cardiopulmonary bypass time, decreased post-operative left ventricular ejection fraction, and high inotropic score were significant risk factors for the development of post-operative arrhythmias.

Keywords

• Arrhythmia
• cardiopulmonary bypass
• inotropic score
• left ventricular ejection fraction