Abstract
Ectopic atrial tachycardia (EAT) is common in surgically repaired congenital heart disease (CHD) and carries the potential for significant hemodynamic compromise. Our objective was to determine the incidence, and risk factors of EAT after CHD surgery. Prospective study of patients that underwent surgery for CHD from February to October 2016 was performed. Demographic, perioperative and electrophysiologic data were collected. Sustained EAT (> 30 s) was documented by telemetry or electrocardiogram and confirmed by a pediatric electrophysiologist. All patients were followed through index hospitalization. During the study period, 17/204 (8%) of patients developed EAT with median time-to-event of 14 days. 15/17 (88%) received anti-arrhythmic therapy for sustained EAT. By univariate analysis, younger age (5 vs. 284 days, P < .001), lower weight (3.2 vs. 7.5 kg, P < .001), single ventricle physiology (P = .05), longer cardiopulmonary bypass time (176 vs. 94 min, P < .001), need for delayed sternal closure (P < .001), and higher STAT category (P < .001) were associated with EAT. Incidence among single ventricle patients was 7/44 (16%), and of those 7/13 (54%) were < 30 days of age. Multivariable Cox regression analysis confirmed age at surgery < 30 days (hazard ratio = 11.7, P = .002) and use of milrinone (hazard ratio = 4.4, P = .007) as independent predictors of EAT. Post-operative EAT is frequent following surgery for CHD especially in neonates. Further study is warranted, specifically in the single ventricle population, given the high potential risk for arrhythmia-induced hemodynamic compromise in this vulnerable population.
Similar content being viewed by others
References
Valsangiacomo E, Schmid ER, Schüpbach RW et al (2002) Early postoperative arrhythmias after cardiac operation in children. Ann Thorac Surg 74:792–796
Talwar S, Patel K, Juneja R et al (2015) Early postoperative arrhythmias after pediatric cardiac surgery. Asian Cardiovasc Thorac Ann 23:795–801. https://doi.org/10.1177/0218492315585457
Delaney JW, Moltedo JM, Dziura JD et al (2006) Early postoperative arrhythmias after pediatric cardiac surgery. J Thorac Cardiovasc Surg 131:1296–1300. https://doi.org/10.1016/j.jtcvs.2006.02.010
Rekawek J, Kansy A, Miszczak-Knecht M et al (2007) Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period. J Thorac Cardiovasc Surg 133:900–904. https://doi.org/10.1016/j.jtcvs.2006.12.011
Pfammatter J-P, Wagner B, Berdat P et al (2002) Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects. J Thorac Cardiovasc Surg 123:258–262
Rosales AM, Walsh EP, Wessel DL, Triedman JK (2001) Postoperative ectopic atrial tachycardia in children with congenital heart disease. Am J Cardiol 88:1169–1172
Shamszad P, Cabrera AG, Kim JJ et al (2012) Perioperative atrial tachycardia is associated with increased mortality in infants undergoing cardiac surgery. J Thorac Cardiovasc Surg 144(2):396–401. https://doi.org/10.1016/j.jtcvs.2012.01.026
O’Brien SM, Clarke DR, Jacobs JP et al (2009) An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 138(5):1139–1153. https://doi.org/10.1016/j.jtcvs.2009.03.071
Katz MH (2011) Multivariable analysis: a practical guide for clinicians and public health researchers. Cambridge University Press, Cambridge
McFerson MC, McCanta AC, Pan Z et al (2014) Tachyarrhythmias after the Norwood procedure: relationship and effect of vasoactive agents. Pediatr Cardiol 35:668–675. https://doi.org/10.1007/s00246-013-0836-8
Oster ME, Chen S, Dagincourt N et al (2016) Development and impact of arrhythmias after the Norwood procedure: a report from the Pediatric Heart Network. J Thorac Cardiovasc Surg 153(638–645):e2. https://doi.org/10.1016/j.jtcvs.2016.10.078
Gist KM, Schuchardt EL, Moroze MK et al (2014) Tachyarrhythmia following Norwood operation. World J Pediatr Congenit Heart Surg 5:206–210. https://doi.org/10.1177/2150135113516982
Hehir DA, Dominguez TE, Ballweg JA et al (2008) Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 136:19–25. https://doi.org/10.1016/j.jtcvs.2007.12.012
Smith AH, Owen J, Borgman KY et al (2011) Relation of milrinone after surgery for congenital heart disease to significant postoperative tachyarrhythmias. Am J Cardiol 108:1620–1624. https://doi.org/10.1016/j.amjcard.2011.07.023
Moak JP, Arias P, Kaltman JR et al (2013) Postoperative junctional ectopic tachycardia: risk factors for occurrence in the modern surgical era. PACE Pacing Clin Electrophysiol 36:1156–1168. https://doi.org/10.1111/pace.12163
Burkhardt B, Rücker G, Stiller B (2011) Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease (Protocol). Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009515
Funding
The authors received no funding for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors disclose no conflicts interest related to this manuscript.
Informed Consent
The authors received a waiver of consent for this study from the Institutional Review Board at Children’s National Medical Center.
Rights and permissions
About this article
Cite this article
Clark, B.C., Berger, J.T., Berul, C.I. et al. Risk Factors for Development of Ectopic Atrial Tachycardia in Post-operative Congenital Heart Disease. Pediatr Cardiol 39, 459–465 (2018). https://doi.org/10.1007/s00246-017-1773-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-017-1773-8