Arrhythmia in Early Post Cardiac Surgery in Pediatrics: Siriraj Experience
Kanoknaphat Chaiyarak MD*, Jarupim Soongswang MD**, Kritvikrom Durongpisitkul MD**, Duangmanee Laohaprasitiporn MD**, Prakul Chanthong MD**, Apichart Nana MD**, Somchai Sriyodcharti MD***, Thaworn Subtaweesin MD***, Ungkab Prakanrattana MD****
Affiliation : * Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok ** Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok *** Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok **** Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Objectives: To determine the incidence, risk factors and outcome of early postoperative arrhythmias in pediatric
patients with congenital heart disease.
Material and Method: A prospective study was conducted in every pediatric patient who consecutively
underwent open-heart surgery at Siriraj Hospital from January 1st to December 31st, 2006. The collected data
were demographic data, diagnosis, pre-operative arrhythmia, cardiac surgical data and continuous electro-
cardiographic monitoring data throughout the post operative intensive care period.
Results : A total of 191 pediatric patients underwent cardiac surgery Forty-five cases (23.5%) developed early
post operative cardiac arrhythmias i.e. junctional ectopic tachycardia 18 cases (40%), heart block 7 cases
(15.6%), supraventricular tachycardia 2 cases (4.4%). Cardiac arrhythmia occurred mostly within 24 hours
after the operation. Patients with single ventricle physiology repaired developed the highest incidence of
acute post operative arrhythmia (36.4%). Longer, cardiopulmonary bypass time, and redo-operation were the
risk factors. Thirty-nine cases were treated with medications, 7 cases with temporary pacing, and 1 case with
electrical cardioversion. Four patients needed long-term anti-arrhythmic agents. Cardiac arrhythmia played
role in the causes of death in 2 cases (1.1% of total cases).
Conclusions: Post operative arrhythmias remained common and important complications of pediatric open-
heart surgery. Long cardiopulmonary bypass time and redo-operation were risk factors for early post opera-
tive arrhythmia.
Keywords : Post operative arrhythmia, Congenital heart diseases, Junctional ectopic tachycardia
