Arrhythmias in the paediatric intensive care unit

A prospective study of the rates and predictors of arrhythmias in children without underlying cardiac disease

Gina N. Cassel-Choudhury, Scott I. Aydin, Iris Toedt-Pingel, Henry Michael Ushay, James S. Killinger, Hillel W. Cohen, Scott R. Ceresnak

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective Arrhythmias are common in patients admitted to the paediatric intensive care unit. We sought to identify the rates of occurrence and types of arrhythmias, and determine whether an arrhythmia was associated with illness severity and paediatric intensive care unit length of stay. Design This is a prospective, observational study of all patients admitted to the paediatric intensive care unit at the Children's Hospital at Montefiore from March to June 2012. Patients with cardiac disease or admitted for the treatment of primary arrhythmias were excluded. Clinical and laboratory data were collected and telemetry was reviewed daily. Tachyarrhythmias were identified as supraventricular tachycardia, ventricular tachycardia, and arrhythmias causing haemodynamic compromise or for which an intervention was performed. Results A total of 278 patients met the inclusion criteria and were analysed. There were 97 incidences of arrhythmia in 53 patients (19%) and six tachyarrhythmias (2%). The most common types of arrhythmias were junctional rhythm (38%), premature atrial contractions (24%), and premature ventricular contractions (22%). Tachyarrhythmias included three supraventricular tachycardia (50%) and three ventricular tachycardia (50%). Of the six tachyarrhythmias, four were related to placement or migration of central venous lines and two occurred during aminophylline infusion. Patients with an arrhythmia had longer duration of mechanical ventilation and paediatric intensive care unit stay (p<0.001). In multivariate analysis, central venous lines (odds ratio 3.1; 95% confidence interval 1.3-7.2, p=0.009) and aminophylline use (odds ratio 5.1; 95% confidence interval 1.7-14.9, p=0.003) were independent predictors for arrhythmias. Conclusions Arrhythmias were common in paediatric intensive care unit patients (19%), although tachyarrhythmias occurred rarely (2%). Central venous lines and use of aminophylline were identified as two clinical factors that may be associated with development of an arrhythmia.

Original languageEnglish (US)
Pages (from-to)1281-1289
Number of pages9
JournalCardiology in the Young
Volume25
Issue number7
DOIs
StatePublished - Oct 2 2014

Fingerprint

Pediatric Intensive Care Units
Cardiac Arrhythmias
Heart Diseases
Prospective Studies
Tachycardia
Aminophylline
Supraventricular Tachycardia
Ventricular Tachycardia
Odds Ratio
Atrial Premature Complexes
Confidence Intervals
Telemetry
Ventricular Premature Complexes
Artificial Respiration
Observational Studies
Length of Stay
Multivariate Analysis
Hemodynamics

Keywords

  • aminophylline
  • Arrhythmias
  • central venous line
  • children
  • intensive care unit

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Arrhythmias in the paediatric intensive care unit : A prospective study of the rates and predictors of arrhythmias in children without underlying cardiac disease. / Cassel-Choudhury, Gina N.; Aydin, Scott I.; Toedt-Pingel, Iris; Ushay, Henry Michael; Killinger, James S.; Cohen, Hillel W.; Ceresnak, Scott R.

In: Cardiology in the Young, Vol. 25, No. 7, 02.10.2014, p. 1281-1289.

Research output: Contribution to journalArticle

Cassel-Choudhury, Gina N. ; Aydin, Scott I. ; Toedt-Pingel, Iris ; Ushay, Henry Michael ; Killinger, James S. ; Cohen, Hillel W. ; Ceresnak, Scott R. / Arrhythmias in the paediatric intensive care unit : A prospective study of the rates and predictors of arrhythmias in children without underlying cardiac disease. In: Cardiology in the Young. 2014 ; Vol. 25, No. 7. pp. 1281-1289.
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abstract = "Objective Arrhythmias are common in patients admitted to the paediatric intensive care unit. We sought to identify the rates of occurrence and types of arrhythmias, and determine whether an arrhythmia was associated with illness severity and paediatric intensive care unit length of stay. Design This is a prospective, observational study of all patients admitted to the paediatric intensive care unit at the Children's Hospital at Montefiore from March to June 2012. Patients with cardiac disease or admitted for the treatment of primary arrhythmias were excluded. Clinical and laboratory data were collected and telemetry was reviewed daily. Tachyarrhythmias were identified as supraventricular tachycardia, ventricular tachycardia, and arrhythmias causing haemodynamic compromise or for which an intervention was performed. Results A total of 278 patients met the inclusion criteria and were analysed. There were 97 incidences of arrhythmia in 53 patients (19{\%}) and six tachyarrhythmias (2{\%}). The most common types of arrhythmias were junctional rhythm (38{\%}), premature atrial contractions (24{\%}), and premature ventricular contractions (22{\%}). Tachyarrhythmias included three supraventricular tachycardia (50{\%}) and three ventricular tachycardia (50{\%}). Of the six tachyarrhythmias, four were related to placement or migration of central venous lines and two occurred during aminophylline infusion. Patients with an arrhythmia had longer duration of mechanical ventilation and paediatric intensive care unit stay (p<0.001). In multivariate analysis, central venous lines (odds ratio 3.1; 95{\%} confidence interval 1.3-7.2, p=0.009) and aminophylline use (odds ratio 5.1; 95{\%} confidence interval 1.7-14.9, p=0.003) were independent predictors for arrhythmias. Conclusions Arrhythmias were common in paediatric intensive care unit patients (19{\%}), although tachyarrhythmias occurred rarely (2{\%}). Central venous lines and use of aminophylline were identified as two clinical factors that may be associated with development of an arrhythmia.",
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AB - Objective Arrhythmias are common in patients admitted to the paediatric intensive care unit. We sought to identify the rates of occurrence and types of arrhythmias, and determine whether an arrhythmia was associated with illness severity and paediatric intensive care unit length of stay. Design This is a prospective, observational study of all patients admitted to the paediatric intensive care unit at the Children's Hospital at Montefiore from March to June 2012. Patients with cardiac disease or admitted for the treatment of primary arrhythmias were excluded. Clinical and laboratory data were collected and telemetry was reviewed daily. Tachyarrhythmias were identified as supraventricular tachycardia, ventricular tachycardia, and arrhythmias causing haemodynamic compromise or for which an intervention was performed. Results A total of 278 patients met the inclusion criteria and were analysed. There were 97 incidences of arrhythmia in 53 patients (19%) and six tachyarrhythmias (2%). The most common types of arrhythmias were junctional rhythm (38%), premature atrial contractions (24%), and premature ventricular contractions (22%). Tachyarrhythmias included three supraventricular tachycardia (50%) and three ventricular tachycardia (50%). Of the six tachyarrhythmias, four were related to placement or migration of central venous lines and two occurred during aminophylline infusion. Patients with an arrhythmia had longer duration of mechanical ventilation and paediatric intensive care unit stay (p<0.001). In multivariate analysis, central venous lines (odds ratio 3.1; 95% confidence interval 1.3-7.2, p=0.009) and aminophylline use (odds ratio 5.1; 95% confidence interval 1.7-14.9, p=0.003) were independent predictors for arrhythmias. Conclusions Arrhythmias were common in paediatric intensive care unit patients (19%), although tachyarrhythmias occurred rarely (2%). Central venous lines and use of aminophylline were identified as two clinical factors that may be associated with development of an arrhythmia.

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