Predictors of Cardiac arrhythmias in early postoperative period after surgery for congenital heart disease

  • Dr Savitri Shrivastava, Escorts Heart Institute and Research center, New Delhi, India
  • Dr Neeraj Awasthy, Escorts Heart Institute and Research center, New Delhi, India
  • Dr Kartikeya Bhargava, Escorts Heart Institute and Research center, New Delhi, India
  • Dr Munesh Tomar, Escorts Heart Institute and Research center, New Delhi, India
  • Dr S Radhakrishnan, Escorts Heart Institute and Research center, New Delhi, India
  • Dr Parvati Iyer, Escorts Heart Institute and Research center, New Delhi, India
  • Dr K Iyer, Escorts Heart Institute and Research center, New Delhi, India

    • Objective: To analyze the incidence and type of cardiac arrhythmias (CA) and find the predictors of their occurrence in early post-operative period after surgery for congenital heart diseases (CHD).

    Methods: Occurrence of early postoperative CA was prospectively analyzed in 511 consecutive patients undergoing surgery for various CHD between November 2007 & August 2008. Various risk factors including demographic (age, sex), operative [type of surgery, cardiopulmonary bypass time(CPBT), aortic crossclamp time] and postoperative metabolic parameters (electrolyte levels, blood gases, inotropic support)were assessed. Statistical analysis was done using the SPSS 17.0 software.

    Results: CA occurred in 35 % (n= 178/511) patients and were more common after Fontan surgery, complex CHD surgery and VSD closure. Most common types of CA were premature ventricular ectopics (VPC s), 45%, junctional ectopic tachycardia (JET) 26%, atrial tachyarrythmias (atrial tachycardia / flutter) 18%, atrioventricular block (9%), ventricular tachyarrhythmias (VF/ VT), 1.5%. Predictors of CA on univariate analysis were lower age, late presenters, longer CPBT (> 75 minutes), aortic crossclamp time(> 50 minutes), hypokalemia and hypercarbia .In the multivariate logistic regression analysis, aortic cross clamp time and hypercarbia were found to be independent predictors of occurrence of CA.

    Conclusion: Longer aortic crossclamp time during surgery and hypercarbia in the post operative period were found to be independent predictors of occurrence of CA in early postoperative period after CHD surgery and should be avoided.