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ABSTRACT
OBJECTIVES: The objectives of this study were to determine the frequency and characteristics of early postoperative arrhythmias, factors associated with their occurrence, and their treatment in children after cardiac surgery.
METHODOLOGY: This was a retrospective and analytic study in children operated at the Cardiac Center Shisong (Cameroon) between January 2010 and December 2013. Information on demographic, pre-operative, surgical and post-operative characteristics was extracted from each patient’s medical record. Arrhythmias were classified as sinus bradycardia, sinus tachycardia, atrial flutter, etc...
RESULTS: A total of 150 children were recruited. The most common arrhythmias were supra-ventricular tachycardia (35.3%), sinus bradycardia (19.6%) and junctional ectopic tachycardia (15.7%). Arrhythmias appeared mainly in the first 24 hours postoperative (57.4%). Amiodarone was the most commonly used antiarrhythmic drug. After a multivariate logistic regression analysis, weight between 5 and 9 kg (p < 0.001) and open heart surgery (p < 0.01) were the factors that remained significantly associated with arrhythmias.
CONCLUSION: Early postoperative arrhythmias are common after pediatric cardiac surgery and the most common is supra-ventricular tachycardia. Children with weight ranging between 5 and 9 kg and those who undergo an open heart surgery are at risk of developing arrhythmias.
RÉSUMÉ
OBJECTIFS: Les objectifs de cette étude étaient de déterminer la fréquence et les caractéristiques des arythmies postopératoires précoces, les facteurs liés à leur fréquence, et leur traitement chez les enfants après une chirurgie cardiaque.
MÉTHODOLOGIE: Nous avons réalisé une étude rétrospective, analytique chez les enfants opérés au Centre de chirurgie cardiaque de Shisong (Cameroun) entre Janvier 2010 et Décembre 2013. Les informations sur les données démographiques, les caractéristiques pré et post-opératoires des patients, la chirurgie réalisée ont été obtenues à partir du dossier médical de chaque patient. Les arythmies ont été classées en bradycardie sinusale, tachycardie sinusale, flutter auriculaire,...
RÉSULTATS: Un total de 150 enfants ont été recrutés. Les arythmies les plus fréquentes étaient la tachycardie supra-ventriculaire (35,3%), bradycardie sinusale (19,6%) et la tachycardie ectopique jonctionnelle (15,7%). Les arythmies sont apparues principalement dans les 24 premières heures post-opératoires (57,4%). L’Amiodarone était l'antiarythmique le plus utilisé. Après une régression logistique multivariée, le poids entre 5 et 9 kg (p <0,001) et la chirurgie à cœur ouvert (p <0,01) ont été les facteurs qui restaient significativement associés à des arythmies.
CONCLUSION: Les arythmies postopératoires précoces sont fréquentes après une chirurgie cardiaque pédiatrique et la tachycardies supra-ventriculaire est la plus retrouvée. Les patients ayant un poids compris entre 5 et 9 kg et qui ont subi une chirurgie à cœur ouvert sont le plus à risque de développer une arythmie en post opératoire.
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References
- Delaney JW, Moltedo JM, Dziura JD, Kopf GS and Snyder CS, "Early postoperative arrhythmias after pediatric cardiac surgery". J Thorac Cardiovasc Surg. 2006 Jun;131(6):1296–300.
- Alp H, Narin C, Baysal T and Sarıgül A. "Prevalence of and risk factors for early postoperative arrhythmia in children after cardiac surgery", Pediatr Int Of J Jpn Pediatr Soc. 2014 Feb;56(1):19–23.
- Valsangiacomo E, Schmid ER, Schüpbach RW, et al., "Early postoperative arrhythmias after cardiac operation in children", Ann Thorac Surg. 2002 Sep;74(3):792–6.
- Rękawek J, Kansy A, Miszczak-Knecht M et al., "Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period", J Thorac Cardiovasc Surg. 2007 Apr 1;133(4):900–4.
- Hoffman TM, Wernovsky G, Wieand TS et al., "The Incidence of Arrhythmias in a Pediatric Cardiac Intensive Care Unit", Pediatr Cardiol, 2002 Dec 1;23(6):598–604.
- Grosse-Wortmann L, Kreitz S, Grabitz RG et al., "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", J Cardiothorac Surg. 2010 Oct 18;5(1):85.
- Yıldırım SV, Tokel K, Saygılı B and Varan 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.
- Kamel YH and Sewielam M, "Arrhythmias as Early Post-operative Complications of Cardiac Surgery in Children at Cairo University", J Med Sci. 2009 Mar 1;9(3):126–32.
- Kouchoukos NT, Blackstone, EH Doty DB, Hanley FL and Karp RB. "Kirklin/Barratt-Boyes cardiac surgery : morphology, diagnostic criteria, natural history, techniques, results, and indications". 3rd ed. Philadelphia, Pa: Churchill Livingstone; 2003.
- Chaiyarak K, Soongswang J, Durongpisitkul K et al., "Arrhythmia in early post cardiac surgery in pediatrics: Siriraj experience", J Med Assoc Thai. 2008 Apr;91(4):507–14.
- Côté JM and Chetaille P. "Complications rythmiques de la chirurgie des cardiopathies congénitales" Arch Cardiovasc Dis Suppl. 2012 Sep;4(2):171–8.
- Deal BJ, Mavroudis C, Jacobs, JP Gevitz M and Backer CL, "Arrhythmic complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease", Cardiol Young. 2008;18(Supplement S2):202–5.
- WHO, World Health Organisation. Child Growth Standards: methods and development. [Internet]. Available from: http://www.who.int/nutrition/publications/childgrowthstandards_technical_report_1/en/. [cited 2014 Oct 8].
- Pfammatter JP, Wagner B, Berdat P et al., "Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects", J Thorac Cardiovasc Surg. 2002;123(2):258–62.
- Saul JP, Scott WA, Brown S, et al., "Intravenous Amiodarone for Incessant Tachyarrhythmias in Children A Randomized, Double-Blind, Antiarrhythmic Drug Trial", Circulation 2005 Nov 29;112(22):3470–7.
- Kovacikova L, Hakacova N, Dobos D, Skrak P and Zahorec M, "Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia", Ann Thorac Surg. 2009;88(2):616–22.
References
Delaney JW, Moltedo JM, Dziura JD, Kopf GS and Snyder CS, "Early postoperative arrhythmias after pediatric cardiac surgery". J Thorac Cardiovasc Surg. 2006 Jun;131(6):1296–300.
Alp H, Narin C, Baysal T and Sarıgül A. "Prevalence of and risk factors for early postoperative arrhythmia in children after cardiac surgery", Pediatr Int Of J Jpn Pediatr Soc. 2014 Feb;56(1):19–23.
Valsangiacomo E, Schmid ER, Schüpbach RW, et al., "Early postoperative arrhythmias after cardiac operation in children", Ann Thorac Surg. 2002 Sep;74(3):792–6.
Rękawek J, Kansy A, Miszczak-Knecht M et al., "Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period", J Thorac Cardiovasc Surg. 2007 Apr 1;133(4):900–4.
Hoffman TM, Wernovsky G, Wieand TS et al., "The Incidence of Arrhythmias in a Pediatric Cardiac Intensive Care Unit", Pediatr Cardiol, 2002 Dec 1;23(6):598–604.
Grosse-Wortmann L, Kreitz S, Grabitz RG et al., "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", J Cardiothorac Surg. 2010 Oct 18;5(1):85.
Yıldırım SV, Tokel K, Saygılı B and Varan 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.
Kamel YH and Sewielam M, "Arrhythmias as Early Post-operative Complications of Cardiac Surgery in Children at Cairo University", J Med Sci. 2009 Mar 1;9(3):126–32.
Kouchoukos NT, Blackstone, EH Doty DB, Hanley FL and Karp RB. "Kirklin/Barratt-Boyes cardiac surgery : morphology, diagnostic criteria, natural history, techniques, results, and indications". 3rd ed. Philadelphia, Pa: Churchill Livingstone; 2003.
Chaiyarak K, Soongswang J, Durongpisitkul K et al., "Arrhythmia in early post cardiac surgery in pediatrics: Siriraj experience", J Med Assoc Thai. 2008 Apr;91(4):507–14.
Côté JM and Chetaille P. "Complications rythmiques de la chirurgie des cardiopathies congénitales" Arch Cardiovasc Dis Suppl. 2012 Sep;4(2):171–8.
Deal BJ, Mavroudis C, Jacobs, JP Gevitz M and Backer CL, "Arrhythmic complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease", Cardiol Young. 2008;18(Supplement S2):202–5.
WHO, World Health Organisation. Child Growth Standards: methods and development. [Internet]. Available from: http://www.who.int/nutrition/publications/childgrowthstandards_technical_report_1/en/. [cited 2014 Oct 8].
Pfammatter JP, Wagner B, Berdat P et al., "Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects", J Thorac Cardiovasc Surg. 2002;123(2):258–62.
Saul JP, Scott WA, Brown S, et al., "Intravenous Amiodarone for Incessant Tachyarrhythmias in Children A Randomized, Double-Blind, Antiarrhythmic Drug Trial", Circulation 2005 Nov 29;112(22):3470–7.
Kovacikova L, Hakacova N, Dobos D, Skrak P and Zahorec M, "Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia", Ann Thorac Surg. 2009;88(2):616–22.