Revisiting risk factors and incidence of postoperative tachyarrhythmias in pediatric cardiac surgery

Postoperative tachyarrhythmias are a significant complication following pediatric congenital heart surgery. This study revisits the incidence and risk factors for postoperative tachyarrhythmias, focusing on congenital heart disease with a higher propensity for arrhythmias. We aim to determine if surgical and perioperative improvements have mitigated these risks. The findings may inform clinical practices and guide the development of preventive strategies. This retrospective cohort study was conducted at a tertiary university hospital, including pediatric patients under 18 years of age who underwent elective surgeries for ventricular septal defect (VSD) and/or right ventricular outflow tract (RVOT) obstruction variants between February 2018 and October 2021. Exclusion criteria included preexisting arrhythmias requiring treatment and intraoperative mortality. Data were collected from medical records. The primary outcome was the incidence and risk factors of postoperative tachyarrhythmias. Independent risk factors for these tachyarrhythmias were identified using multivariable logistic regression. Among the 385 patients included, with a median age of 24.8 months, 49 (12.7%) patients developed postoperative tachyarrhythmias, predominantly junctional ectopic tachycardia (JET; n = 46). The highest incidence was observed in patients with DORV with VSD (41.4%) and AVSD (26.7%). Independent risk factors included younger age, with each 6-month increase in age reducing the odds by 10% (adjusted OR 0.90, 95% CI 0.84-0.98, p = 0.009); prolonged CPB duration, with a 44% increase in odds per 30-minute increment (adjusted OR 1.44, 95% CI 1.20-1.73, p < 0.001); and the use of del Nido cardioplegia (adjusted OR 2.36, 95% CI 1.01-5.52, p = 0.047). Patients with postoperative tachyarrhythmias required significantly longer durations of mechanical ventilation, as well as extended intensive care unit and hospital stays. Postoperative tachyarrhythmias remain a significant concern in pediatric congenital heart surgery, especially in younger patients and those with complex heart defects. Strategies to reduce CPB duration and manage systemic hyperinflammation may lower the risk. Further research is needed to explore inflammatory processes in the development of these arrhythmias.