Risk Factors for Development of Ectopic Atrial Tachycardia in Post-operative Congenital Heart Disease

Bradley C. Clark, John T. Berger, Charles I. Berul, Richard A. Jonas, Jonathan R. Kaltman, Julianne Lapsa, Dilip S. Nath, Elizabeth D. Sherwin, Pranava Sinha, David Zurakowski, Jeffrey P. Moak

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Ectopic atrial tachycardia (EAT) is common in surgically repaired congenital heart disease (CHD) and carries the potential for significant hemodynamic compromise. Our objective was to determine the incidence, and risk factors of EAT after CHD surgery. Prospective study of patients that underwent surgery for CHD from February to October 2016 was performed. Demographic, perioperative and electrophysiologic data were collected. Sustained EAT (> 30 s) was documented by telemetry or electrocardiogram and confirmed by a pediatric electrophysiologist. All patients were followed through index hospitalization. During the study period, 17/204 (8%) of patients developed EAT with median time-to-event of 14 days. 15/17 (88%) received anti-arrhythmic therapy for sustained EAT. By univariate analysis, younger age (5 vs. 284 days, P < .001), lower weight (3.2 vs. 7.5 kg, P < .001), single ventricle physiology (P = .05), longer cardiopulmonary bypass time (176 vs. 94 min, P < .001), need for delayed sternal closure (P < .001), and higher STAT category (P < .001) were associated with EAT. Incidence among single ventricle patients was 7/44 (16%), and of those 7/13 (54%) were < 30 days of age. Multivariable Cox regression analysis confirmed age at surgery < 30 days (hazard ratio = 11.7, P = .002) and use of milrinone (hazard ratio = 4.4, P = .007) as independent predictors of EAT. Post-operative EAT is frequent following surgery for CHD especially in neonates. Further study is warranted, specifically in the single ventricle population, given the high potential risk for arrhythmia-induced hemodynamic compromise in this vulnerable population.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalPediatric Cardiology
DOIs
StateAccepted/In press - Nov 17 2017
Externally publishedYes

Fingerprint

Ectopic Atrial Tachycardia
Heart Diseases
Hemodynamics
Milrinone
Telemetry
Anti-Arrhythmia Agents
Incidence
Vulnerable Populations
Cardiopulmonary Bypass
Thoracic Surgery
Cardiac Arrhythmias
Electrocardiography
Hospitalization
Regression Analysis
Demography
Newborn Infant
Prospective Studies
Pediatrics

Keywords

  • Arrhythmia
  • Atrial tachycardia
  • Congenital heart disease
  • Post-operative care

ASJC Scopus subject areas

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

Cite this

Clark, B. C., Berger, J. T., Berul, C. I., Jonas, R. A., Kaltman, J. R., Lapsa, J., ... Moak, J. P. (Accepted/In press). Risk Factors for Development of Ectopic Atrial Tachycardia in Post-operative Congenital Heart Disease. Pediatric Cardiology, 1-7. https://doi.org/10.1007/s00246-017-1773-8

Risk Factors for Development of Ectopic Atrial Tachycardia in Post-operative Congenital Heart Disease. / Clark, Bradley C.; Berger, John T.; Berul, Charles I.; Jonas, Richard A.; Kaltman, Jonathan R.; Lapsa, Julianne; Nath, Dilip S.; Sherwin, Elizabeth D.; Sinha, Pranava; Zurakowski, David; Moak, Jeffrey P.

In: Pediatric Cardiology, 17.11.2017, p. 1-7.

Research output: Contribution to journalArticle

Clark, BC, Berger, JT, Berul, CI, Jonas, RA, Kaltman, JR, Lapsa, J, Nath, DS, Sherwin, ED, Sinha, P, Zurakowski, D & Moak, JP 2017, 'Risk Factors for Development of Ectopic Atrial Tachycardia in Post-operative Congenital Heart Disease', Pediatric Cardiology, pp. 1-7. https://doi.org/10.1007/s00246-017-1773-8
Clark, Bradley C. ; Berger, John T. ; Berul, Charles I. ; Jonas, Richard A. ; Kaltman, Jonathan R. ; Lapsa, Julianne ; Nath, Dilip S. ; Sherwin, Elizabeth D. ; Sinha, Pranava ; Zurakowski, David ; Moak, Jeffrey P. / Risk Factors for Development of Ectopic Atrial Tachycardia in Post-operative Congenital Heart Disease. In: Pediatric Cardiology. 2017 ; pp. 1-7.
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abstract = "Ectopic atrial tachycardia (EAT) is common in surgically repaired congenital heart disease (CHD) and carries the potential for significant hemodynamic compromise. Our objective was to determine the incidence, and risk factors of EAT after CHD surgery. Prospective study of patients that underwent surgery for CHD from February to October 2016 was performed. Demographic, perioperative and electrophysiologic data were collected. Sustained EAT (> 30 s) was documented by telemetry or electrocardiogram and confirmed by a pediatric electrophysiologist. All patients were followed through index hospitalization. During the study period, 17/204 (8{\%}) of patients developed EAT with median time-to-event of 14 days. 15/17 (88{\%}) received anti-arrhythmic therapy for sustained EAT. By univariate analysis, younger age (5 vs. 284 days, P < .001), lower weight (3.2 vs. 7.5 kg, P < .001), single ventricle physiology (P = .05), longer cardiopulmonary bypass time (176 vs. 94 min, P < .001), need for delayed sternal closure (P < .001), and higher STAT category (P < .001) were associated with EAT. Incidence among single ventricle patients was 7/44 (16{\%}), and of those 7/13 (54{\%}) were < 30 days of age. Multivariable Cox regression analysis confirmed age at surgery < 30 days (hazard ratio = 11.7, P = .002) and use of milrinone (hazard ratio = 4.4, P = .007) as independent predictors of EAT. Post-operative EAT is frequent following surgery for CHD especially in neonates. Further study is warranted, specifically in the single ventricle population, given the high potential risk for arrhythmia-induced hemodynamic compromise in this vulnerable population.",
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