Key result
Postoperative arrhythmias linked to ~3.4-fold higher risk of pediatric low cardiac output.
Why the study?
Postoperative arrhythmias are common in children after congenital cardiac surgery and may compromise hemodynamic stability and recovery, but their impact on outcomes requires assessment.
Does postoperative arrhythmia worsen hemodynamics and clinical outcomes in children under 18 years of age following congenital cardiac surgery?
Observational (n=329)
Does postoperative arrhythmia worsen hemodynamics and clinical outcomes in children under 18 years of age following congenital cardiac surgery?
Relative Risk: 3.43 (95% CI 2.27–5.17)
p-value: p=<.001
Postoperative arrhythmias in children following congenital cardiac surgery are associated with adverse hemodynamics, but this likely reflects pre-existing underlying instability rather than a primary causal factor.
Postoperative arrhythmias may reflect pre-existing instability rather than cause low output in pediatric congenital surgery; leaves open causality and need for prospective trials.
Background Postoperative arrhythmias are common among children after congenital cardiac surgery, potentially compromising hemodynamic stability and postoperative recovery. This study aimed to assess the impact of arrhythmias on hemodynamics and clinical outcomes. Material and Methods Three hundred and twenty-nine children under 18 years of age undergoing congenital cardiac surgery were studied prospectively. In addition to standard postoperative hemodynamic monitoring, electrical cardiometry (ICON ® ) was used to assess hemodynamic parameters across time points (prearrhythmia, during arrhythmia, and postarrhythmia). Repeated measures were analyzed using Friedman test followed by Wilcoxon signed-rank test with Bonferroni correction for pairwise comparisons. Poisson regression with robust variance estimation was used to identify independent predictors and calculate incidence rate ratios (IRR). Results Postoperative arrhythmias occurred in 53/329 patients (16.1%). Junctional ectopic tachycardia (34%, [18/53]) and supraventricular tachycardia (30.2%, [16/53]) were the most common. Arrhythmias were associated with low cardiac output (IRR 3.43; 95% confidence interval [CI] 2.27-5.17; P < .001), ventricular dysfunction (IRR 2.55; P < .001), acute kidney injury (IRR 2.01; P = .006), and liver dysfunction (IRR 4.56; P = .002) on unadjusted analysis. However, these associations were attenuated after adjustment for prearrhythmia hemodynamic variables like central venous pressure (CVP) and vasoactive-inotropic score (VIS) on multivariable analysis. Elevated CVP, VIS, and hypokalemia were predictors of arrhythmia. Conclusions Arrhythmias occurred in approximately one-sixth of children following congenital cardiac surgery and were associated with adverse hemodynamic changes, organ function, and recovery. However, these associations were attenuated after adjustment for prearrhythmia hemodynamic variables (CVP and VIS), suggesting that arrhythmia may reflect underlying instability rather than a primary causal factor.
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D et al. (2026) conducted an observational in Congenital heart disease requiring cardiac surgery (n=329). Postoperative arrhythmia vs. No postoperative arrhythmia was evaluated on Low cardiac output (unadjusted) (IRR 3.43, 95% CI 2.27-5.17, p=<.001). Postoperative arrhythmias occurred in 16.1% of children and were associated with low cardiac output (unadjusted IRR 3.43; 95% CI 2.27-5.17), which attenuated after multivariable adjustment.
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