Reference : Prevalence of and risk factors for perioperative arrhythmias in neonates and children...
Scientific journals : Article
Human health sciences : Pediatrics
Prevalence of and risk factors for perioperative arrhythmias in neonates and children after cardiopulmonary bypass: continuous holter monitoring before and for three days after surgery.
Grosse-Wortmann, Lars [> > > >]
Kreitz, Suzanna [> > > >]
Grabitz, Ralph G [> > > >]
Vazquez-Jimenez, Jaime F [> > > >]
Messmer, Bruno J [> > > >]
von Bernuth, Goetz [> > > >]
SEGHAYE, Marie-Christine mailto [ > > ]
Journal of cardiothoracic surgery
Yes (verified by ORBi)
[en] Adolescent ; Arrhythmias, Cardiac/diagnosis/epidemiology/etiology ; Cardiopulmonary Bypass ; Child ; Child, Preschool ; Electrocardiography, Ambulatory ; Female ; Heart Defects, Congenital/surgery ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Male ; Postoperative Complications/diagnosis/epidemiology/etiology ; Prevalence ; Prospective Studies ; Risk Factors ; Statistics, Nonparametric
[en] BACKGROUND: A comprehensive evaluation of postoperative arrhythmias following surgery for congenital heart disease by continuous Holter monitoring has not been carried out. We aimed, firstly, to establish the time course of pre- and early postoperative arrhythmias by beat-to-beat analysis following cardiopulmonary bypass and, secondly, to examine which surgical procedures present risk factors for specific arrhythmias. METHODS: 494 consecutive patients, including 96 neonates, were studied with serial 24-hour Holter electrocardiograms before as well as uninterruptedly during the first 72 hours after surgery and prior to discharge. RESULTS: Within 24 hours of surgery 59% of the neonates and 79% of the older children developed arrhythmias. Junctional ectopic tachycardia occurred in 9% of neonates and 5% of non-neonates and ventricular tachycardia in 3% and 15%, respectively.For neonates, male sex and longer cross-clamping time independently increased the risk for arrhythmias (odds ratios 2.83 and 1.96/minute, respectively). Ventricular septal defect repair was a strong risk factor for junctional ectopic tachycardia in neonates and in older children (odds ratios 18.8 and 3.69, respectively). For infants and children, older age (odds ratio 1.01/month) and closure of atrial septal defects (odds ratio 2.68) predisposed to arrhythmias of any type. CONCLUSIONS: We present the largest cohort of neonates, infants and children that has been prospectively studied for the occurrence of arrhythmias after cardiac surgery. Postoperative arrhythmias are a frequent and transient phenomenon after cardiopulmonary bypass, provoked both by mechanical irritation of the conduction system and by humoral factors.

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