Risk factors of early postoperative cardiac arrhythmia after pediatric cardiac surgery: A single-center experience

Rahaf K. Alotaibi; Abdulmuti S. Saleem; Fai F. Alsharef; Zainab A. Alnemer; Yazan M. Saber; Gaser A. Abdelmohsen; Saud A. Bahaidarah

doi:10.15537/smj.2022.43.10.20220275

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Figure 1
- Management of junctional ectopic tachycardia

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Table 1

- Demographic and clinical characteristics of studied patients (N=821).

Variables	n (%)
*Gender*
Male Female	448 (54.6) 373 (45.4)
*Nationality*
Non-Saudi Saudi	706 (86.0) 115 (14.0)
*Age groups*
<1 month 1-6 months >6-12 months >1-6 years >6-12 years >12-18 years	45 (5.5) 184 (22.4) 188 (22.9) 257 (31.3) 125 (15.2) 22 (2.7)
Height (cm), median (IQR)	71 (57-97)
Weight (Kg), median (IQR)	7.4 (4.2-13)
BMI, median (IQR)	14.15 (12.5-16)
Hemodynamically instability	171 (20.8)
*Presence of electrolyte disturbances*	743 (90.5)
Abnormal serum sodium level Abnormal serum potassium level Abnormal serum calcium level Abnormal serum magnesium level	525 (70.7) 311 (41.9) 395 (53.2) 635 (85.5)
Hypoxia	272 (33.1)
*Abnormal body temperature*
Hyperthermia Hypothermia	35 (67.3) 17 (32.7)
CPB time (minutes), median (IQR)	63 (47-84)
AXC time (minutes), median (IQR)	47 (32-63)

Values are presented as a number and precentage (%).

BMI: body mass index, CPB: cardiopulmonary bypass,

AXC: aortic cross-clamp, IQR: interquartile range (25th-75th percentile)

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Table 2

- Arrhythmia types, duration, and onset in patients who had postoperative arrhythmias.

Type of arrhythmia	Frequency of arrhythmia	Duration of arrhythmia, n			Postoperative day of onset, n
		<24 hours	24-48 hours	>48 hours	1^st day	2^nd day	3^rd day	After 3^rd day
SVT	14 (10.0)	7	3	4	7	2	0	5
PVC	4 (2.9)	0	3	1	1	0	1	2
JET	72 (51.4)	39	12	21	58	9	1	4
AV block III	38 (27.1)	14	3	21	34	1	2	1
AV block II	1 (0.7)	1	0	0	1	0	0	0
AV block I	2 (1.4)	1	1	0	1	0	0	1
V-tach	2 (1.4)	2	0	0	2	0	0	0
V-fib	2 (1.4)	2	0	0	2	0	0	0
Atrial fib	3 (2.1)	2	1	0	3	0	0	0
Other	2 (1.4)	1	0	1	2	0	0	0
Total	140 (100)	69	23	48	11	12	4	13

Values are presented as a number and precentage (%). SVT: supraventricular tachycardia, PVC: premature ventricular complex, JET: junctional ectopic tachycardia, AV: atrioventricular, V-tach: ventricular tachycardia, V-fib: ventricular fibrillation, atrial fib: atrial fibrillation

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Table 3

- Comparison between patients having postoperative arrhythmias with no arrhythmia patients after cardiac surgery.

Variables	Arrhythmia group (n=140)	No arrhythmia groups (n=681)	P-values
*Age groups*
<1 month 1-6 months >6-12 months >1-6 years >6-12 years >12-18 years	9 (6.4) 42 (30.0) 34 (24.3) 39 (27.9) 13 (9.3) 3 (2.1)	36 (5.3) 142 (21.0) 154 (22.6) 218 (32.0) 112 (16.4) 19 (2.8)	0.091
Weight (Kg), median (IQR)	6.6 (4-12.8)	7.4 (4.4-13)	0.351
CPB time (minutes), median (IQR)	77 (57-99.5)	60 (45-81)	0.0001*
AXC time (minutes), median (IQR)	54 (38-70)	45 (32-62)	0.005*
Hemodynamic instability	49 (35.0)	122 (18.0)	0.0001*
Abnormal body temperature	9 (6.4)	43 (6.3)	0.960
Hypoxemia	50 (35.7)	222 (32.6)	0.510
Electrolytes imbalance	134 (95.7)	609 (89.4)	0.021*

Values are presented as a number and precentage (%). *Statistically significant. CPB: cardiopulmonary bypass, AXC: aortic cross-clamp, IQR: interquartile range (25th-75th percentile)

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Table 4

- Predictors for developing postoperative arrhythmias after cardiac surgery.

Variables	Univariate logistic regression analysis		Multivariate logistic regression analysis
	OR (95% CI)	P-values	OR (95% CI)	P-values
AXC time	1.011 (1.003-1.019)	0.009^*	0.995 (0.979-1.010)	0.500
Associated electrolyte disturbances	2.640 (1.125-6.200)	0.026^*	2.310 (0.804-6.634)	0.120
Associated hemodynamic instability	2.467 (1.656-3.766)	0.0001^*	1.772 (1.104-2.884)	0.018^*
CPB duration	1.014 (1.008-1.019)	0.0001^*	1.014 (1.002-1.027)	0.024^*

↵* Statistically significant. AXC: aortic cross-clamping, CPB: cardiopulmonary bypass, OR: odds ratio, CI: confidence interval

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Appendix 1

- Types of cardiac operations carried out.

Type of operations	n	%
Atrioventricular septal defect repair	65	7.9
Atrial septal defect repair	30	3.7
Ventricular septal defect repair	146	17.8
Teratology of Fallot repair	111	13.5
Right ventricle outflow tract resection	3	0.4
Double outlet right ventricle repair	16	1.9
Transposition of the great arteries repair	66	8.0
*Pulmonary vein surgery*
Total anomalous pulmonary venous drainage repair Pulmonary artery pulmonary venous drainage-atrial septal defect repair Pulmonary vein stenosis repair	18 1 3	2.2 0.1 0.4
*Aortic valve/arch repair surgery*
Interrupted aortic arch repair Coarctation repair Aortic arch repair Patch aorto-plasty Subaortic posterior annulus patch Aortic valvuloplasty Aortic valve replacement Left ventricular outflow tract fibro-myectomy Ross AVR	6 31 7 4 1 9 3 21 1	0.7 3.8 0.9 0.5 0.1 1.1 0.4 2.6 0.1
*Pulmonary artery surgery*
Patent ductus ligation Pulmonary artery plasty	14 4	1.7 0.5
*Mitral valve surgery*
Mitral valvuloplasty Mitral annuloplasty Mitral valve replacement Supravalvular mitral ring resection Cor-triatriatum repair	8 11 8 1 2	1.0 1.3 1.0 0.1 0.2
*Pulmonary valve surgery*
Pulmonary valvuloplasty Pulmonary valvotomy Pulmonary valve replacement	1 2 4	0.1 0.2 0.5
Tricuspid valve surgery	3	0.4
*Rastelli operation*	5	0.6
Conduit right ventricle to the pulmonary artery - valved	9	1.1
*Single ventricle palliation*
Glenn shunt Norwood operation Fontan operation Damus-Kaye-Stansel connection	78 17 48 4	9.5 2.1 5.8 0.5
Central Shunt with graft	3	0.4
Coronary repair anomalous left coronary artery from the pulmonary artery	1	0.1
Truncus arteriosus repair	9	1.1
Blalock-taussig	8	1.0
*Other*	7	0.8
A-P window repair Atrial septectomy Unifocalization of pulmonary atresia Ventricular septal defect enlargement Vascular ring repair Pulmonary artery banding-MPA Pulmonary artery de-banding Extracorporeal membrane oxygenation Pacemaker-primary implant	3 4 6 1 2 7 1 6 2	0.4 0.5 0.7 0.1 0.2 0.9 0.1 0.7 0.2
Total	821	100.0