Occurrence of significant post-operative arrhythmias in paediatric cardiac surgery patients at an academic hospital

Abstract

Background: The immediate post-operative period constitutes a vulnerable time for paediatric patients who have undergone cardiac surgery as they are at risk of developing haemodynamically significant arrhythmias which, could lead to morbidity and mortality. The occurrence of haemodynamically significant arrhythmias in the immediate post-operative period in these patients at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was previously unknown. Objectives: To ascertain the occurrence of significant post-operative arrhythmias in paediatric cardiac surgery patients at CMJAH, and secondly to describe these arrhythmias and identify predisposing risk factors. Methods: This was a retrospective study that looked at clinical records over a 3 year period of patients 18 years and younger. The study was conducted in the cardiothoracic unit at CMJAH. The age, weight, cardiac defect, cardiopulmonary bypass time, aortic cross clamp time as well as magnesium, potassium and calcium levels were documented. Results: Of the 459 patients who had cardiac surgery, 17 were excluded due to incomplete records. Fifty-three (12%) developed post-operative arrhythmias, of which, 40 (75.5%) occurred within 24 hours of surgery. Supraventricular tachycardia (SVT) 14 (26.4%), junctional ectopic tachycardia (JET) 6 (11.3%) and atrioventricular block (AVB) 7 (13.2%) occurred most frequently. Ventricular septal defect, Tetralogy of Fallot, mitral valve regurgitation, atrioventricular septal defect and coarctation of the aorta, were more common in the arrhythmia patient group. Arrhythmias were more likely to occur in patients with the presence of 2 (p=0.0170) or 3 (p=0.0420) defects. Conclusion: The occurrence of haemodynamically significant post-operative arrhythmias in paediatric cardiac surgery patients at CMJAH was 12% which is comparable to other studies.