Postoperative Ectopic Atrial Tachycardia in Children with Congenital Heart Disease

The causes and significance of postoperative ectopic atrial tachycardia (EAT) remain unknown. To identify factors associated with postoperative EAT in children after cardiac surgery, we retrospectively studied pre-, intra-, and postoperative variables. The median age for postoperative EAT cases was younger than the general population admitted for cardiac surgical procedures (6 vs 17 months old, p = 0.09). Trends for EAT cases included lower preoperative oxygen saturation (84% vs 99%, p = 0.001), more pre- and postoperative inotropic support, and atrial septostomy (24% vs 6%, p = 0.08). EAT cases had longer cardiopulmonary bypass times and clamp times (115 vs 88 minutes, p = 0.08; 63 vs 46 minutes, p = 0.03, respectively) and had a prolonged intensive care unit stay (10 vs 3 days, p <0.001). Deaths were recorded in 2 of 17 EAT cases versus 0 of 36 randomly selected controls (p = 0.10). EAT resolved before discharge in 10 of 16 surviving patients. The etiology of EAT appears to be multifactorial, and may include disruption of atrial septum, longer pump times, need for inotropic support, and potassium depletion. Thus, young, ill, cyanotic patients were most at risk for postoperative EAT. Although EAT was associated with prolonged intensive care, it resolved in most cases over time.