Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects

Objectives: Early postoperative arrhythmias frequently are a relevant problem in the early postoperative management after surgical intervention for congenital heart disease. Few data are available indicating risk factors for their occurrence. The hypothesis was tested that factors closely related to the surgical procedure itself were associated with a higher incidence of arrhythmias early in the postoperative course after repair of congenital heart disease. Methods: All consecutive patients undergoing 1 of 3 well-defined surgical procedures were prospectively evaluated for the occurrence of arrhythmias during the entire postoperative hospital stay by means of continuous electrocardiographic monitoring in the intensive care unit and use of 24-hour Holter monitors. Patients examined were those undergoing transatrial closure of a ventricular septal defect, repair of complete atrioventricular canal, and tetralogy of Fallot. The relation between procedural variables and the occurrence of arrhythmias was independently evaluated for each of these 3 heart defects. Results: Early postoperative arrhythmias occurred in 30% of patients with ventricular septal defect (n = 75), 35% of patients with tetralogy of Fallot (n = 52), and 47% of patients with atrioventricular canal (n = 45). Patients with arrhythmias tended to be younger (significant only in the ventricular septal defect group). In all 3 patient groups, there was a significant correlation between incidence of arrhythmias and longer extracorporeal bypass time (P < .05) and longer aortic crossclamp time (P < .01), as well as with higher maximum postoperative troponin serum levels (P < .01). In patients with atrioventricular canal, there was a significant relation between hemodynamically incomplete surgical results and the occurrence of arrhythmias (P < .01). Conclusions: The occurrence of early postoperative arrhythmias after repair of congenital heart disease was significantly associated with procedure-related risk factors in each of 3 independent patient groups undergoing well-defined surgical procedures.