Diagnosis and Management of Arrhythmias in Children After Cardiac Surgery

Abstract

Arrhythmias that lead to hemodynamic deterioration and sudden death are one of the most challenging problems in children after cardiac surgery. In infants with congenital heart disease, disorders of impulse conduction are more frequent than those of impulse generation. Various factors that include anatomic or physiologic abnormalities of the conduction system, damage as a result of hemodynamic stress or chronic hypoxia, and injury occurring at the time of surgery interact to produce dysrhythmias. During the post operative period, supraventricular tachycardia rarely causes sudden death in children. However, junctional ectopic tachy cardia and Wolff-Parkinson-White syndrome are 2 that have been associated with a high mortality rate. In general, ven tricular tachycardia carries a more serious prognosis than supraventricular tachycardia because it typically occurs in abnormal myocardium with suboptimal function, which may also be vulnerable to degeneration into ventricular fi brillation. A practical approach to the most common intra operative and postoperative arrhythmias in pediatric cardiac patients is discussed. Patients at risk, the types of arrhyth mias likely to occur after specific cardiac operations, and the most effective current therapies are reviewed.