Early and Late Postoperative Tachyarrhythmias in Children and Young Adults Undergoing Congenital Heart Disease Surgery

Overview

Journal Pediatr Cardiol

Specialties Cardiology & Vascular Diseases
Pediatrics

Date 2022 Dec 14

PMID 36517587

Authors

Raphael Joye

Maurice Beghetti

Julie Wacker

Iliona Malaspinas

Maya Bouhabib

Angelo Polito

Alice Bordessoule

Dipen C Shah

Affiliations

Soon will be listed here.

Abstract

The population of patients with congenital heart disease is constantly growing with an increasing number of individuals reaching adulthood. A significant proportion of these children and young adults will suffer from tachyarrhythmias due to the abnormal anatomy, the hemodynamic burden, or as a sequela of surgical treatment. Depending on the underlying mechanism, arrhythmias may arise in the early postoperative period (hours to days after surgery) or in the late postoperative period (usually years after surgery). A good understanding of the electrophysiological characteristics and pathophysiological mechanisms is therefore crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, risk factors, pathophysiological insights, electrophysiological features, and therapy regarding tachyarrhythmias in children and young adults undergoing reparative surgery for congenital heart disease. The evolution and latest data on treatment options, including pharmacological therapy, ablation procedures, device therapy decision, and thromboprophylaxis, are summarized. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.

Citing Articles

Ivabradine for Incessant Atrial Tachycardia in a 1-Year-Old Child After Tetralogy of Fallot Repair.

Balweel H, Sukardi R, Marwali E, Eri R, Tafriend N, Harsoyo A Case Rep Cardiol. 2025; 2025:2601345.

PMID: 39963303 PMC: 11832250. DOI: 10.1155/cric/2601345.

Early postoperative tachyarrhythmias in adult congenital heart surgery: an eight-year review at a tertiary university hospital in Thailand.

Maisat W, Lapmahapaisan S J Thorac Dis. 2024; 16(9):5936-5945.

PMID: 39444867 PMC: 11494597. DOI: 10.21037/jtd-24-771.

Discovery and functional investigation of as a new causative gene for human congenital heart disease.

Wang Z, Liu X, Yang C, Zhou H, Li Y, Qiu X Am J Transl Res. 2024; 16(5):2034-2048.

PMID: 38883374 PMC: 11170606. DOI: 10.62347/DGCD4269.

Cardiac Arrhythmias Requiring Electric Countershock during the Neonatal Period-A Systematic Review.

Oeffl N, Krainer M, Kurath-Koller S, Koestenberger M, Schwaberger B, Urlesberger B Children (Basel). 2023; 10(5).

PMID: 37238386 PMC: 10263252. DOI: 10.3390/children10050838.

References

Delaney J, Moltedo J, Dziura J, Kopf G, Snyder C . Early postoperative arrhythmias after pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2006; 131(6):1296-300. DOI: 10.1016/j.jtcvs.2006.02.010. View

Pfammatter J, Bachmann D, Wagner B, Pavlovic M, Berdat P, Carrel T . Early postoperative arrhythmias after open-heart procedures in children with congenital heart disease. Pediatr Crit Care Med. 2003; 2(3):217-222. DOI: 10.1097/00130478-200107000-00005. View

Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J . Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace. 2013; 15(9):1337-82. DOI: 10.1093/europace/eut082. View

Khairy P, Van Hare G, Balaji S, Berul C, Cecchin F, Cohen M . PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society.... Can J Cardiol. 2014; 30(10):e1-e63. DOI: 10.1016/j.cjca.2014.09.002. View

Pfammatter J, Wagner B, Berdat P, Bachmann D, Pavlovic M, Pfenninger J . Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects. J Thorac Cardiovasc Surg. 2002; 123(2):258-62. DOI: 10.1067/mtc.2002.119701. View

Shamszad P, Cabrera A, Kim J, Moffett B, Graves D, Heinle J . Perioperative atrial tachycardia is associated with increased mortality in infants undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2012; 144(2):396-401. DOI: 10.1016/j.jtcvs.2012.01.026. View

Clark B, Berger J, Berul C, Jonas R, Kaltman J, Lapsa J . Risk Factors for Development of Ectopic Atrial Tachycardia in Post-operative Congenital Heart Disease. Pediatr Cardiol. 2017; 39(3):459-465. DOI: 10.1007/s00246-017-1773-8. View

Rosales A, Walsh E, Wessel D, Triedman J . Postoperative ectopic atrial tachycardia in children with congenital heart disease. Am J Cardiol. 2001; 88(10):1169-72. DOI: 10.1016/s0002-9149(01)02055-0. View

Kammeraad J, Balaji S, Oliver R, Chugh S, Halperin B, Kron J . Nonautomatic focal atrial tachycardia: characterization and ablation of a poorly understood arrhythmia in 38 patients. Pacing Clin Electrophysiol. 2003; 26(3):736-42. DOI: 10.1046/j.1460-9592.2003.00125.x. View

10.

Seslar S, Alexander M, Berul C, Cecchin F, Walsh E, Triedman J . Ablation of nonautomatic focal atrial tachycardia in children and adults with congenital heart disease. J Cardiovasc Electrophysiol. 2006; 17(4):359-65. DOI: 10.1111/j.1540-8167.2006.00354.x. View

11.

Salerno J, Kertesz N, Friedman R, Fenrich Jr A . Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children < 3 or > or =3 years of age. J Am Coll Cardiol. 2004; 43(3):438-44. DOI: 10.1016/j.jacc.2003.09.031. View

12.

Kang K, Etheridge S, Kantoch M, Tisma-Dupanovic S, Bradley D, Balaji S . Current management of focal atrial tachycardia in children: a multicenter experience. Circ Arrhythm Electrophysiol. 2014; 7(4):664-70. DOI: 10.1161/CIRCEP.113.001423. View

13.

Hernandez-Madrid A, Paul T, Abrams D, Aziz P, Blom N, Chen J . Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up.... Europace. 2018; 20(11):1719-1753. DOI: 10.1093/europace/eux380. View

14.

Janson C, Tan R, Iyer V, Vogel R, Vetter V, Shah M . Ivabradine for treatment of tachyarrhythmias in children and young adults. HeartRhythm Case Rep. 2019; 5(6):333-337. PMC: 6587055. DOI: 10.1016/j.hrcr.2019.03.007. View

15.

Hackett G, Lin T, Imundo J . Use of ivabradine in a critically ill pediatric patient with recalcitrant ectopic atrial tachycardia and complex congenital heart disease. HeartRhythm Case Rep. 2022; 8(6):415-419. PMC: 9237372. DOI: 10.1016/j.hrcr.2022.03.011. View

16.

Saoudi N, Cosio F, Waldo A, Chen S, Iesaka Y, Lesh M . A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases; a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology.... Eur Heart J. 2001; 22(14):1162-82. DOI: 10.1053/euhj.2001.2658. View

17.

Bouchardy J, Therrien J, Pilote L, Ionescu-Ittu R, Martucci G, Bottega N . Atrial arrhythmias in adults with congenital heart disease. Circulation. 2009; 120(17):1679-86. DOI: 10.1161/CIRCULATIONAHA.109.866319. View

18.

Chubb H, Whitaker J, Williams S, Head C, Chung N, Wright M . Pathophysiology and Management of Arrhythmias Associated with Atrial Septal Defect and Patent Foramen Ovale. Arrhythm Electrophysiol Rev. 2016; 3(3):168-72. PMC: 4711537. DOI: 10.15420/aer.2014.3.3.168. View

19.

Gelatt M, Hamilton R, McCrindle B, Connelly M, Davis A, Harris L . Arrhythmia and mortality after the Mustard procedure: a 30-year single-center experience. J Am Coll Cardiol. 1997; 29(1):194-201. DOI: 10.1016/s0735-1097(96)00424-x. View

20.

Fishberger S, Wernovsky G, Gentles T, Gauvreau K, Burnett J, Mayer Jr J . Factors that influence the development of atrial flutter after the Fontan operation. J Thorac Cardiovasc Surg. 1997; 113(1):80-6. DOI: 10.1016/s0022-5223(97)70402-1. View