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Incidence and recovery of post-surgical heart block in children following cardiac surgery

Published online by Cambridge University Press:  29 July 2022

Rohit Madani*
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Elizabeth Aronoff
Affiliation:
Emory University School of Medicine, Atlanta, GA, USA
Jessica Posey
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Mohua Basu
Affiliation:
Qualitative Analyst, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Tawanda Zinyandu
Affiliation:
Senior Research Coordinator, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Paul Chai
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Robert Whitehill
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Kevin O. Maher
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Asaad G. Beshish
Affiliation:
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
*
Author for correspondence: Rohit Madani, MD, Children’s Healthcare of Atlanta, Emory University School of Medicine, 2835 Brandywine Rd, Suite 400, Atlanta, GA 30341, USA. Tel: +1 – 248 – 840 – 2619. E-mail: rsmadani@gmail.com

Abstract

Background:

A subset of patients who develop post-surgical heart block have recovery of atrioventricular node function. Factors predicting recovery are not understood. We investigated our centre’s incidence of post-surgical heart block and examine factors associated with recovery of atrioventricular node function.

Methods:

We conducted a single-centre retrospective study of patients 0 – 21 years who underwent cardiac surgery between January 2010 and December 2019 and experienced post-operative heart block. Data including patient and clinical characteristics and operative variables were collected and analysed.

Results:

Of 6333 surgical hospitalisations, 128 (2%) patients developed post-operative heart block. Of the 128 patients, 90 (70%) had return of atrioventricular node function, and 38 (30%) had pacemaker placement. Of the 38 patients who underwent pacemaker placement, 6 (15.8%) had recovery of atrioventricular node function noted on long-term follow-up. Median time from onset of heart block to late atrioventricular node recovery was 13 days (Interquartile range: 5 – 117). Patients with single-ventricle physiology (p = 0.04), greater weight (p = 0.03), and shorter cardiopulmonary bypass time (p = 0.015) were more likely to have recovery. The use of post-operative steroids was similar between all groups (p = 0.445). Infectious or wound complications were similar between pacemaker groups (p = 1).

Conclusions:

Two per cent of patients who underwent congenital cardiac surgery developed post-operative heart block, and 0.6% underwent pacemaker placement. Early recovery of atrioventricular node was associated with greater weight at the time of surgery, single-ventricle physiology, and shorter cardiopulmonary bypass time. Late recovery of atrioventricular node conduction following pacemaker placement occurred in 15.8% of patients.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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