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Postoperative Arrhythmias and Their Management

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Congenital Heart Disease in Pediatric and Adult Patients

Abstract

Early cardiac arrhythmias are well-known complications of pediatric cardiac surgery. These arrhythmias are also a major cause of mortality and morbidity. Several reports have been published regarding late postoperative arrhythmias after pediatric cardiac surgeries. Nevertheless, data related to the early postoperative period after cardiac surgery in children are limited. Arrhythmias that may be easily tolerated in normal heart can have a major influence on hearts with congenital defects. Postoperative cardiac arrhythmias range from simple atrial or ventricular ectopies to major arrhythmias such as atrial flutter/fibrillation or ventricular tachycardia (VT). Other common arrhythmias are junctional ectopic tachycardia or complete atrioventricular block (CHB) after any manipulation on conduction system. Several factors, including myocardial dysfunction, electrolyte disturbances, adrenergic stimulation, sutures in the myocardium, residual hemodynamic impairment, as well as pain and anxiety, have been implicated in the pathogenesis of early postoperative arrhythmias in children. The aim of this chapter is to present an overview of the common cardiac arrhythmias occurring in immediate postoperative period.

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References

  • Andersen H, de Leval MR, Tsang V. Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann Thorac Surg. 2006;82:948–57.

    Article  PubMed  Google Scholar 

  • Batra AS, Wells WJ, Hinoki KW. Late recovery of atrioventricular conduction after pacemaker implantation for complete heart block associated with surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2003;125:1291–3.

    Article  PubMed  Google Scholar 

  • Batra AS, Chun DS, Johnson TR. A prospective analysis of the incidence and risk factors associated with junctional ectopic tachycardia following surgery for congenital heart disease. Pediatr Cardiol. 2006;27(1):51–5.

    Article  CAS  PubMed  Google Scholar 

  • Bink-Boelkens MT, Meuzelaar KJ, Eygelaar A. Arrhythmias after repair of secundum atrial septal defect: the influence of surgical modification. Am Heart J. 1988;115(3):629–33.

    Article  CAS  PubMed  Google Scholar 

  • Bonatti V, Agnetti A, Squarcia U. Early and late postoperative complete heart block in pediatric patients submitted to open-heart surgery for congenital heart disease. Pediatr Med Chir. 1998;20:181–6.

    CAS  PubMed  Google Scholar 

  • Brugada J, Blom N, Sarquella-Brugada G. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace. 2013;15:1337–82.

    Article  PubMed  Google Scholar 

  • Chandar JS, Wolff GS, Garson Jr A. Ventricular arrhythmias in postoperative tetralogy of Fallot. Am J Cardiol. 1990;65(9):655–61.

    Article  CAS  PubMed  Google Scholar 

  • Chowdhury UK, Diplomate NB, Airan B. Specific issues after surgical repair of partial atrioventricular septal: actuarial survival, freedom from reoperation, fate of the left atrioventricular valve, prevalence of left ventricular outflow tract obstruction, and other events. J Thorac Cardiovasc Surg. 2009;137:548–55.

    Article  PubMed  Google Scholar 

  • Deanfield JE, McKenna WJ, Presbitero P. Ventricular arrhythmia in unrepaired and repaired tetralogy of Fallot. Relation to age, timing of repair, and hemodynamic status. Br Heart J. 1984;52:77–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Delaney J, Moltedo J, Dziura J. Early postoperative arrhythmias after pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2006;131:1296–301.

    Article  PubMed  Google Scholar 

  • Dodge-Khatami A, Miller OI, Anderson RH. Impact of junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects. Eur J Cardiothorac Surg. 2002;21(2):255–9.

    Article  CAS  PubMed  Google Scholar 

  • Dunnigan A, Pritzker MR, Benditt DL. Life threatening ventricular tachycardias in late survivors of surgically corrected tetralogy of Fallot. Br Heart J. 1984;52:198–206.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Garson A, Gillette PC, Gutgesell HP. Stress-Induced ventricular arrhythmia after repair of tetralogy of Fallot. Am J Cardiol. 1980;46(6):1006–12.

    Article  PubMed  Google Scholar 

  • Gatzoulis MA, Till JA, Somerville J. Mechanoelectrical interaction in tetralogy of Fallot QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation. 1995;92:231–7.

    Article  CAS  PubMed  Google Scholar 

  • Gelatt M, Hamilton RM, Mccrindle BW. Risk factors for atrial tachyarrhythmias after the Fontan Operation. J Am Coll Cardiol. 1994;24(7):1735–41.

    Article  CAS  PubMed  Google Scholar 

  • Gelatt M, Hamilton RM, Mccrindle BW. Arrhythmia and mortality after the mustard procedure: a 30-year single-center experience. JACC. 1997;29(1):194–201.

    Article  CAS  PubMed  Google Scholar 

  • Gillette PC, El-Said GM, Sivarajan N. Electrophysiological abnormalities after Mustard’s operation for transposition of the great arteries. Br Heart J. 1974;36:186–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Girod DA, Fontan F, Deville C. Long term results after the Fontan operation for tricuspid atresia. Circulation. 1987;75:605–10.

    Article  CAS  PubMed  Google Scholar 

  • Ho SY, Anderson RH. Conduction tissue in congenital heart surgery. World J Surg. 1985;9:550–67.

    Article  CAS  PubMed  Google Scholar 

  • Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890–900.

    Article  PubMed  Google Scholar 

  • Hoffman TM, Bush DM, Wernovsky G. Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment. Ann Thorac Surg. 2002;74(5):1607–1.

    Article  PubMed  Google Scholar 

  • Houyel L, Vaksman NG, Fournier A. Ventricular arrhythmias after correction of ventricular septal defects: importance of surgical approach. J Am Coll Cardiol. 1990;16:1224.

    Article  CAS  PubMed  Google Scholar 

  • Huang SK, Wood MA. Catheter ablation of cardiac arrhythmias. Philadelphia: W.B. Saunders; 2006.

    Google Scholar 

  • Huehnergarth KV, Gurvitz M, Stout KK, Otto CM. Repaired tetralogy of Fallot in the adult: monitoring and management. Heart. 2008;94:1663–9.

    Article  PubMed  Google Scholar 

  • Karpawich P, Antillon JR, Cappola PR. Pre- and Postoperative Electrophysiologic Assessment of Children with Secundum Atrial Septal Defect. Am J Cardiol. 1965;55:519–21.

    Article  Google Scholar 

  • Kavey RW, Blackman MS, Sondheimer HM. Incidence and severity of chronic ventricular arrhythmias after repair of tetralogy of Fallot. Am Heart J. 1982;103:342–50.

    Article  CAS  PubMed  Google Scholar 

  • Khairy P, Landzberg MJ, Lambert J, et al. Long-term outcomes after the atrial switch for surgical correction of transposition: a meta-analysis comparing the Mustard and Senning procedures. Cardiol Young. 2004;14:284–92.

    Article  PubMed  Google Scholar 

  • Kleinman ME, Chameides L, Schexnayder SM. Part 14: pediatric advanced life support 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122:S876–908.

    Article  PubMed  Google Scholar 

  • Kovacikova L, Hakacova N, Dobos D. Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia. Ann Thorac Surg. 2009;88:616–22.

    Article  PubMed  Google Scholar 

  • Kurer C, Tanner C, Vetter V. Electrophysiologic findings after Fontan repair of functional single ventricle. J Am Coll Cardiol. 1991;17:174–81.

    Article  CAS  PubMed  Google Scholar 

  • Lan Y, Lee J, Wetzel G. Postoperative arrhythmia. Curr Opin Cardiol. 2003;18:73–8.

    Article  PubMed  Google Scholar 

  • Mayer Jr JE, Sanders SP, Jonas RA, et al. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries. Circulation. 1990;82:139–45.

    Google Scholar 

  • Mildh L, Hiippala A. Rautiainen junctional ectopic tachycardia after surgery for congenital heart disease: incidence, risk factors and outcome. Eur J Cardiothorac Surg. 2011;39(1):75–80.

    Article  PubMed  Google Scholar 

  • Moons P, Gewillig M, Sluysmans T, et al. Long term outcome up to 30 years after the Mustard or Senning operation: a nationwide multicenter study in Belgium. Heart. 2004;90:307–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Murphy JG, Gersh BJ, McGoon MD. Longterm outcome after surgical repair of isolated atrial septal defect: follow-up at 27 to 32 years. N Engl J Med. 1990;323:1645–50.

    Article  CAS  PubMed  Google Scholar 

  • Nürnberg JH, Ovroutski S, Alexi-Meskishvili V. New onset arrhythmias after the extracardiac conduit Fontan Operation compared with the intra-atrial lateral tunnel procedure: early and midterm results. Ann Thorac Surg. 2004;78:1979–88.

    Article  PubMed  Google Scholar 

  • Papagiannis J. Postoperative arrhythmias in tetralogy of Fallot. Hell J Cardiol. 2005;46:402–7.

    Google Scholar 

  • Peretto G, Durante A, Limite LR. Postoperative arrhythmias after cardiac surgery: incidence, risk factors, and therapeutic management. Cardiol Res Pract. 2014;2014:15. Article ID 615987.

    Google Scholar 

  • Perry J, Fenrich A, Edward HJ. Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol. JACC. 1996;27(5):1246–50.

    Article  CAS  PubMed  Google Scholar 

  • Pfammatter JP, Wagner B, Berdat P. Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects. J Thorac Cardiovasc Surg. 2002;123:258–62.

    Article  PubMed  Google Scholar 

  • Porter CJ, Battiste LE, Humes RA. Risk factors for supraventricular tachyarrhythmias after Fontan procedure for tricuspid atresia (abstr). Am Heart J. 1986;112:645.

    Google Scholar 

  • Probst V, Denjoy I, Meregalli PG. Clinical aspects and prognosis of Brugada syndrome in children. Circulation. 2007;115:2042–8.

    Article  PubMed  Google Scholar 

  • Quinton E, Nightingale P, Hudsmith L. Prevalence of atrial tachyarrhythmia in adults after Fontan operation. Heart. 2015;101(20):1672–7. doi:10.1136/heartjnl-2015-307514.

    Article  CAS  PubMed  Google Scholar 

  • Rekawek J, Kansy A, Miszczak-Knecht M. Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period. J Thorac Cardiovasc Surg. 2007;133:900–4.

    Article  PubMed  Google Scholar 

  • Rhodes LA, Wernovsky G, Keane JF. Arrhythmias and intracardiac conduction after the arterial switch operation. J Thorac Cardiovasc Surg. 1995;109(2):303–10.

    Article  CAS  PubMed  Google Scholar 

  • Roos-Hesselinka JW, Meijbooma FJ, Spitaelsa SEC. Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age A prospective follow-up study of 21–33 years. Eur Heart J. 2003;24:190–7.

    Article  Google Scholar 

  • Roos-Hesselinka JW, Meijbooma FJ, Spitaelsa SEC. Outcome of patients after surgical closure of ventricular septal defect at young age follow-up of 22–34 years. Ann Thorac Surg. 2006;82:948–57.

    Article  Google Scholar 

  • Steeds RP, Oakley D. Predicting late sudden death from ventricular arrhythmia in adults following surgical repair of tetralogy of Fallot. Q J Med. 2004;97:7–13.

    Article  CAS  Google Scholar 

  • Texter KM, Kertesz NJ, Friedman RA. Atrial flutter in infants. J Am Coll Cardiol. 2006;48:1040–6.

    Article  PubMed  Google Scholar 

  • Triedman JK. Arrhythmias in adults with congenital heart disease. Heart. 2002;87:383–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tucker EM, Pyles LA, Bass JL. Permanent pacemaker for atrioventricular conduction block after operative repair of perimembranous ventricular septal defect. J Am Coll Cardiol. 2007;50(12):1196–200.

    Article  PubMed  Google Scholar 

  • Walsh EP, Cecchin F. Arrhythmias in adult patients with congenital heart disease. Circulation. 2007;115:534–45.

    Article  PubMed  Google Scholar 

  • Walsh EP, Saul JP, Hulse JE. Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current. Circulation. 1992;86:1138–46.

    Article  CAS  PubMed  Google Scholar 

  • Weber H, Hellenbrand W, Kleinman C. Predictors of rhythm disturbances and subsequent morbidity after the Fontan operation. Am J Cardiol. 1666;64:762–7.

    Article  Google Scholar 

  • Weindling SN, Saul JP, Gamble WJ, Mayer JE, Wessel D, Walsh EP. Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol. 1998;82:525–7.

    Article  CAS  PubMed  Google Scholar 

  • Yildirim SV, Tokel K, Saygili B. The incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients. Turk J Pediatr. 2008;50(6):549–53.

    PubMed  Google Scholar 

  • Zampi J, Hirsch J, Gurney J. Junctional ectopic tachycardia after infant heart surgery: incidence and outcomes. Pediatr Cardiol. 2012;33:1362–9.

    Article  PubMed  Google Scholar 

  • Zeppenfeld K, Schalij MJ, Bartelings MM. Catheter ablation of ventricular tachycardia after repair of congenital heart disease: electroanatomic identification of the critical right ventricular isthmus. Circulation. 2007;116(20):2241–52.

    Article  CAS  PubMed  Google Scholar 

  • Zimmermann M, Friedli B, Adamec R. Ventricular late potentials and induced ventricular arrhythmias after surgical repair of tetralogy of Fallot. Am J Cardiol. 1991;67:873–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

    Majid Haghjoo MD, FESC, FACC & Mohammadrafie Khorgami MD

Authors
  1. Majid Haghjoo MD, FESC, FACC
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  2. Mohammadrafie Khorgami MD
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Correspondence to Majid Haghjoo MD, FESC, FACC .

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Editors and Affiliations

  1. Cardiac Anesthesiology Department, Anesthesiology Research Center Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Ali Dabbagh

  2. Kaiser Permanente Los Angeles Medical Center Division of Cardiac Anesthesiology, Los Angeles, California, USA

    Antonio Hernandez Conte

  3. Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Lorraine Lubin

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Haghjoo, M., Khorgami, M. (2017). Postoperative Arrhythmias and Their Management. In: Dabbagh, A., Conte, A., Lubin, L. (eds) Congenital Heart Disease in Pediatric and Adult Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-44691-2_34

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  • DOI: https://doi.org/10.1007/978-3-319-44691-2_34

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