1
|
Ozturk E, Sisko SG, Sahin GT, Tanıdır IC, Guzeltas A, Haydin S, Hatemi AC, Ergul Y. Comparison of the effects of conventional method and primary sutureless techniques on early postoperative rhythm problems in patients with total abnormal pulmonary venous return anomaly. Cardiol Young 2023; 33:2498-2503. [PMID: 36942512 DOI: 10.1017/s1047951123000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Total abnormal pulmonary venous return anomaly is a CHD characterised by abnormal pulmonary venous flow directed to the right atrium. In this study, we aimed to compare the effects of these techniques on early rhythm problems in total abnormal pulmonary venous return anomaly cases operated with conventional or primary sutureless techniques. METHOD Seventy consecutive cases (median age 1 month, median weight 4 kg) who underwent total abnormal pulmonary venous return anomaly repair with conventional or primary sutureless technique between May 1 2020 and May 1 2022 were evaluated. The rate, diagnosis, and possible risk factors of postoperative arrhythmias were investigated. The results were evaluated statistically. RESULTS When the total abnormal pulmonary venous return anomaly subgroup of 70 cases was evaluated, 40 cases were supracardiac, 18 cases were infracardiac, 7 cases were cardiac, and 5 cases were mixed type. Twenty-eight (40%) cases had a pulmonary venous obstruction. Primary sutureless technique (57%, supracardiac n = 24, mixed = 3, infracardiac = 13) was used in 40 patients. Median cardiopulmonary bypass time (110 versus 95 minutes) and median aortic clamp time (70 versus 60 minutes), median peak lactate (4.7 versus 4.8 mmol/l) in the first 72 hours, and median peak vasoactive inotropic score in the first 72 hours of the primary sutureless and conventional technique used cases value (8 versus 10) were similar. The total incidence of arrhythmias in the conventional group was significantly higher than in the primary sutureless group (46.7% versus 22.5%, p = 0.04). Supraventricular early beat was observed in 3 (7.5%), sinus tachycardia was seen in 6 (15%), junctional ectopic tachycardia was seen in 1 (2.5%), intra-atrial reentry tachycardia was seen in 1 (2.5%), usual supraventricular tachyarrhythmia was seen in 2 cases (5%) in the primary sutureless group. In the conventional group, supraventricular early beat was observed in six of the cases (20%), sinus tachycardia in five (16.7%), junctional ectopic tachycardia in four (13.3%), intra-atrial reentry tachycardia (10%) in three, and supraventricular tachyarrhythmia in seven cases (23.3%). In the first 30 days, there was a similar mortality rate (10% versus 10%), with four patients in the primary sutureless group and three in the conventional group. The median follow-up period of the cases was 8 months (interquartile range (IQR) 6-10 months). In the follow-up, arrhythmias were detected in two cases (one supraventricular tachyarrhythmia and one intra-atrial reentry tachycardia) in the primary sutureless group and three cases (two supraventricular tachyarrhythmia, one intra-atrial reentry tachycardia) in the conventional technique. All cases were converted to normal sinus rhythm with cardioversion and combined antiarrhythmic therapy. CONCLUSION Different arrhythmias can be observed in the early period in patients with operated total abnormal pulmonary venous return anomaly. Although a higher rate of rhythm problems was observed in the early period in the conventional method compared to the primary sutureless technique, no significant effect was found on mortality and morbidity between the groups.
Collapse
Affiliation(s)
- Erkut Ozturk
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
| | - Sezen Gulumser Sisko
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Gulhan Tunca Sahin
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
| | - Ibrahim Cansaran Tanıdır
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Ali Can Hatemi
- Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
2
|
Brown DH, Zhang X, Al-Subu AM, Von Bergen NH. Improvements in Accuracy and Confidence in Rhythm Identification After Cardiac Surgery Using the AtriAmp Signals. J Intensive Care Med 2023; 38:809-815. [PMID: 36938624 DOI: 10.1177/08850666231164613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Objectives: Following cardiac surgery, 50% to 60% of patients with congenital heart disease will experience an arrhythmia. These arrhythmias are associated with increased morbidity and mortality. Therefore, rapid and accurate identification is paramount to the improvement of patient outcome. We hypothesize that the AtriAmp, a device which allows atrial electrogram (AEG) display on the bedside monitors, will increase provider accuracy and confidence in arrhythmia diagnosis. Design: A prospective observational study. Electrograms were collected from post-operative patients from the bedside monitors surface ECG and an AEG using the AtriAmp. A 12-question online survey was given to critical care and cardiology providers at 9 different programs across the country as well as being posted to the AAP SOCC fall newsletter. Six questions displayed signals from only the surface leads, while the other 6 showed the same arrhythmias with an AEG obtained from the AtriAmp. Answers were then evaluated for confidence and accuracy. A paired t-test along with mixed method modeling was used to assess the data. Setting: Cardiac pediatric ICU. Subjects: Providers in pediatric cardiology and pediatric critical care were evaluated on their ability to diagnose arrhythmias on surface ECG and AEG obtained from bedside monitor. Interventions: The accuracy and confidence of diagnosis of both surface and AEG signals were evaluated through an on-line survey. Results: Eighty-eight providers completed the survey. The study showed that interpreting with the AtriAmp signal, compared to the surface ECG only, significantly increased the accuracy (P = .002) and confidence in provider rhythm diagnosis (P < .001). Junctional ectopic tachycardia, sinus tachycardia, and complete heart block had the most significant increase in accuracy of diagnose when using the AtriAmp signal (P < .001, P = .002, P = .010, respectively). Conclusion: Use of the AtriAmp increased provider accuracy and confidence in post-operative rhythm diagnosis when compared to diagnosis using the surface electrograms only.
Collapse
Affiliation(s)
- Diane H Brown
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Xiao Zhang
- Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Awni M Al-Subu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nicholas H Von Bergen
- Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
3
|
Sakai W, Chaki T, Nawa Y, Oyasu T, Ichisaka Y, Nawa T, Asai H, Ebuoka N, Oba J, Yamakage M. Head cooling wrap could suppress the elevation of core temperature after cardiac surgery during forced-air warming in a pediatric intensive care unit: a randomized clinical trial. J Anesth 2023; 37:596-603. [PMID: 37272969 DOI: 10.1007/s00540-023-03210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE The main aim of the current trial was to explore our hypothesis that cooling head wraps lower the core temperature more effectively than ice packs on the head during forced-air warming after pediatric cardiac surgeries. METHODS This study was a single-center Randomized Controlled Trial. Participants were children with a weight ≤ 10 kg and hyperthermia during forced-air warming after cardiac surgeries. When the core temperature reached 37.5 °C, ice packs on the head (group C) or a cooling head wrap (group H) were used as cooling devices to decrease the core temperature. The primary outcome was the core temperature. The secondary outcomes were the foot surface temperature and heart rate. We measured all outcomes every 30 min for 240 min after the patient developed hyperthermia. We conducted two-way ANOVA as a pre-planned analysis and also the Bonferroni test as a post hoc analysis. RESULTS Twenty patients were randomly assigned to groups C and H. The series of core temperatures in group H were significantly lower than those in group C (p < 0.0001), and post hoc analysis showed that there was no significant difference in core temperatures at T0 between the two groups and statistically significant differences in all core temperatures at T30-240 between the two groups. There was no difference between the two groups' surface temperatures and heart rates. CONCLUSIONS Compared to ice packs on the head, head cooling wraps more effectively suppress core temperature elevation during forced-air warming after pediatric cardiac surgery.
Collapse
Affiliation(s)
- Wataru Sakai
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan.
- Department of Anesthesiology, Sapporo Medical University School of Medicine, East 17, South 1, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan.
| | - Tomohiro Chaki
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Anesthesiology, Sapporo Medical University School of Medicine, East 17, South 1, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Yuko Nawa
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Anesthesiology, Sapporo Medical University School of Medicine, East 17, South 1, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Takayoshi Oyasu
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Yuki Ichisaka
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Tomohiro Nawa
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Hidetsugu Asai
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Noriyoshi Ebuoka
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Junichi Oba
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, East 17, South 1, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
| |
Collapse
|
4
|
Dumeny L, Chantra M, Langaee T, Duong BQ, Zambrano DH, Han F, Lopez‐Colon D, Humma JF, Dacosta J, Lovato T, Mei C, Duarte JD, Johnson JA, Peek GJ, Jacobs JP, Bleiweis MS, Cavallari LH. β1-receptor polymorphisms and junctional ectopic tachycardia in children after cardiac surgery. Clin Transl Sci 2022; 15:619-625. [PMID: 34713976 PMCID: PMC8932827 DOI: 10.1111/cts.13178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 01/22/2023] Open
Abstract
Junctional ectopic tachycardia (JET) is a potentially life-threatening postoperative arrhythmia in children with specific congenital heart defects and can contribute significantly to postoperative morbidity for at-risk populations. In adults, β1-adrenergic receptor (ADRB1) and β2-adrenergic receptor (ADRB2) genotypes have been associated with increased risk for arrhythmias. However, their association with arrhythmia risk in children is unknown. We aimed to test associations between ADRB1 and ADRB2 genotypes and postoperative JET in patients with congenital heart defects. Children who underwent cardiac surgery were genotyped for the ADRB1 p.Ser49Gly (rs1801252; c.145A>G), p.Arg389Gly (rs1801253; c.1165C>G), ADRB2 p.Arg16Gly (rs1042713; c.46A>G), and p.Glu27Gln (rs1042714; c.79G>C) polymorphisms. The occurrence of postoperative JET was assessed via cardiologist-interpreted electrocardiograms. Genotype associations with JET were analyzed via logistic regression, adjusted for clinical variables associated with JET, with separate analysis in patients not on a β-blocker. Of the 343 children included (median age 8 months, 53% boys, 69% European ancestry), 45 (13%) developed JET. The Arg389Arg genotype was not significantly associated with JET in the overall population (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 0.96-4.03, p = 0.064), but was nominally associated in patients not taking a β-blocker (n = 324, OR = 2.25, 95% CI = 1.05-4.80. p = 0.034). None of the other variants were associated with JET. These data suggest that the ADRB1 Arg389Arg genotype may predict risk for JET following cardiac surgery in pediatric patients in the absence of β-blockade. Whether treatment with a β-blocker ameliorates this association requires further research.
Collapse
Affiliation(s)
- Leanne Dumeny
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Marut Chantra
- Division of Pediatric Critical CareDepartments of PediatricsCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA,Present address:
Division of Pediatric Critical Care MedicineDepartment of PediatricsFaculty of Medicine Ramathibodi HospitalMahidol UniversityRatchatewi, BangkokThailand
| | - Taimour Langaee
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Benjamin Q. Duong
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA,Present address:
Precision MedicineNemours Children’s HealthWilmingtonDelawareUSA
| | - Daniel H. Zambrano
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Frank Han
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Dalia Lopez‐Colon
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - James F. Humma
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Jonathan Dacosta
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Tommie Lovato
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Connie Mei
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Julio D. Duarte
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Giles J. Peek
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Jeffrey P. Jacobs
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Mark S. Bleiweis
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| |
Collapse
|
5
|
Ishaque S, Akhtar S, Ladak AA, Martins RS, Memon MKY, Kazmi AR, Mahmood F, Haque AU. Early postoperative arrhythmias after pediatric congenital heart disease surgery: a 5-year audit from a lower- to middle-income country. Acute Crit Care 2022; 37:217-223. [PMID: 35172530 PMCID: PMC9184984 DOI: 10.4266/acc.2020.00990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background Arrhythmias are known complication after surgery for congenital heart disease (CHD). This study aimed to identify and discuss their immediate prevalence, diagnosis and management at a tertiary care hospital in Pakistan. Methods A retrospective study was conducted at a tertiary care hospital in Pakistan between January 2014 and December 2018. All pediatric (<18 years old) patients admitted to the intensive care unit and undergoing continuous electrocardiographic monitoring after surgery for CHD were included in this study. Data pertaining to the incidence, diagnosis, and management of postoperative arrhythmias were collected. Results Amongst 812 children who underwent surgery for CHD, 185 (22.8%) developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia, observed in 120 patients (64.9%), followed by complete heart block (CHB) in 33 patients (17.8%). The highest incidence of early postoperative arrhythmia was seen in patients with atrioventricular septal defects (64.3%) and transposition of the great arteries (36.4%). Patients were managed according to the Pediatric Advanced Life Support guidelines. JET resolved successfully within 24 hours in 92% of patients, while 16 (48%) patients with CHB required a permanent pacemaker. Conclusions More than one in five pediatric patients suffered from early postoperative arrhythmias in our setting. Further research exploring predictive factors and the development of better management protocols of patients with CHB are essential for reducing the morbidity and mortality associated with postoperative arrhythmia.
Collapse
|
6
|
Li TT, Cheng J. Clinical analysis of temporary pacemaker implantation in 13 children. Transl Pediatr 2022; 11:174-182. [PMID: 35282021 PMCID: PMC8905110 DOI: 10.21037/tp-21-586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/30/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND At present, temporary pacemaker implantation is very common in the treatment of cardiovascular diseases in adults. However, the number of pediatric pacemakers implanted is still relatively small, and relevant research is also far less than that of adults. This study aimed to explore the application of temporary pacemakers in children with acute and critical cardiovascular diseases. METHODS The clinical data of children with cardiovascular diseases who were treated with temporary pacemakers in Tianjin Children's Hospital from October 2017 to February 2021 were analyzed retrospectively. RESULTS A total of 13 children with cardiovascular diseases were included in this study, including 4 males and 9 females, mean age of 71.2±56.3 months, and median body weight of 15.5 kg. There were 9 children with endocardial pacing and 4 children with epicardial pacing. The types of diseases included fulminant myocarditis (n=8), complete atrioventricular block (CAVB; n=1), and arrhythmias after open heart surgery (n=4). The median time from onset to admission was 1.0 days in children with endocardial pacing and there was cardiac arrest in 2 children, heart failure in 9 children, cardiogenic shock in 8 children, and Adams-Stokes attack in 7 children. The median time from admission to implantation of temporary pacemakers was 3.0 h and the operation time was 55.0±19.4 min. All 4 children with epicardial pacing had pacemakers implanted during operation because of CAVB. The pacing mode was VVI mode. The initial perceptual voltage was 1-2 mv, the output voltage was 5v, and the pacing frequency was 70-145 bpm. A total of 11 children reverted to sinus rhythm within 5.0 (1.8-34.0) h and the working time of temporary pacemakers was 134.0 (15.0-191.0) h. There was poor pacing in 2 children and catheter displacement in 1 child during pacing. A total of 12 children were followed up for 20.0±12.5 months and 1 was lost to follow-up. During the follow-up period, the cardiac functions were basically normal and no new arrhythmia appeared. CONCLUSIONS Temporary pacemakers have the advantage of simple operation, definite effect, and safety which has a remarkable effect in the treatment of acute and critical cardiovascular diseases in children.
Collapse
Affiliation(s)
- Ting-Ting Li
- Department of Cardiology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Ji Cheng
- Department of Cardiology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| |
Collapse
|
7
|
Tan X, Dai Y, Humayun AI, Chen H, Allen GI, Jain PN. Detection of Junctional Ectopic Tachycardia by Central Venous Pressure. ACTA ACUST UNITED AC 2021; 12721:258-262. [PMID: 34278383 PMCID: PMC8281976 DOI: 10.1007/978-3-030-77211-6_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Central venous pressure (CVP) is the blood pressure in the venae cavae, near the right atrium of the heart. This signal waveform is commonly collected in clinical settings, and yet there has been limited discussion of using this data for detecting arrhythmia and other cardiac events. In this paper, we develop a signal processing and feature engineering pipeline for CVP waveform analysis. Through a case study on pediatric junctional ectopic tachycardia (JET), we show that our extracted CVP features reliably detect JET with comparable results to the more commonly used electrocardiogram (ECG) features. This machine learning pipeline can thus improve the clinical diagnosis and ICU monitoring of arrhythmia. It also corroborates and complements the ECG-based diagnosis, especially when the ECG measurements are unavailable or corrupted.
Collapse
Affiliation(s)
- Xin Tan
- Department of Statistics, Rice University, Houston, TX, USA
| | - Yanwan Dai
- Department of Statistics, Rice University, Houston, TX, USA
| | - Ahmed Imtiaz Humayun
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, USA
| | - Haoze Chen
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, USA
| | - Genevera I Allen
- Departments of ECE, Statistics, and Computer Science, Rice University, TX, USA.,Neurological Research Institute, Baylor College of Medicine, Houston, TX, USA
| | | |
Collapse
|
8
|
Early postoperative arrhythmias in patients undergoing congenital heart surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:27-35. [PMID: 33768978 PMCID: PMC7970075 DOI: 10.5606/tgkdc.dergisi.2021.20366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate early postoperative arrhythmias in children undergoing congenital cardiac surgery. Methods A total of 670 pediatric patients (355 males, 315 females; median age: 4 months; range, 1 day to 18 years) who underwent cardiac surgery due to congenital heart defects between December 2018 and November 2019 were included. The rate of postoperative arrhythmias, diagnosis, potential risk factors, and management strategies were evaluated. Multivariate regression analysis was used to identify significant factors of development of postoperative arrhythmias. Results Tachyarrhythmia was detected in 54 patients (8.1%), and the most common tachyarrhythmia was junctional ectopic tachycardia. Medical treatment was required in 25/38 (66%) of junctional ectopic tachycardia patients. Amiodarone was initiated in 18, dexmedetomidine in five, and flecainide + amiodarone in two of the patients. Different degrees of atrioventricular block were observed in 30 patients (4.5%). In 12 patients, permanent pacemakers were implanted during hospitalization. Age at the time of surgery under one-year-old, high inotropic scores, prolonged operation time, and high Aristotele"s scores were independent risk factors associated with early postoperative arrhythmia (p<0.05). The most common operations associated with early postoperative arrhythmia were left ventricular outflow tract, (6/20, 30%), complete atrioventricular septal defect (13/53, 24%), and tetralogy of Fallot (20/134, 14%) surgeries. Conclusion Cardiac arrhythmias are common in the early period after congenital heart surgery in children. The diagnosis and frequency of arrhythmias may vary according to different surgical procedures.
Collapse
|
9
|
Paluszek C, Brenner P, Pichlmaier M, Haas NA, Dalla-Pozza R, Hagl C, Hakami L. Risk Factors and Outcome of Post Fallot Repair Junctional Ectopic Tachycardia (JET). World J Pediatr Congenit Heart Surg 2019; 10:50-57. [PMID: 30799715 DOI: 10.1177/2150135118813124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Junctional ectopic tachycardia (JET) is a common arrhythmia causing hemodynamic impairment following corrective cardiac surgery such as tetralogy of Fallot (TOF) repair. METHODS We report our experience with postoperative JET following surgical repair of TOF. The retrospective study was done from 2003 to 2012 with a total of 105 patients who underwent TOF repair. These patients' clinical and electrocardiographic data (pre-, intra-, and postoperative) were monitored to identify risk factors for the occurrence of JET and to evaluate the outcome of the affected patients. RESULTS Incidence-Fourteen patients developed JET, with only four patients going directly from sinus rhythm to JET. In all others, either a transient atrioventricular (AV) block or a junctional rhythm preceded JET, mostly intraoperatively, showing a significant relation ( P = .010). Age-Patients with JET were of younger age ( P = .025) and had longer cardiopulmonary bypass ( P = .044) and aortic cross-clamping times ( P = .038). Increased cost and care-The occurrence of JET was associated with a longer stay in the intensive care unit (ICU) and a prolonged need for inotropic support and mechanical ventilation. Time to rate control correlated with length of ICU and hospital stay. MORTALITY All JET patients converted into sinus rhythm, one of them died shortly after cessation of JET and two patients subsequently developed a first-degree AV block. CONCLUSION The occurrence of JET remains an important complication during the initial postoperative period by increasing mechanical ventilation time, the need for inotropic support, and prolonging the length of ICU and hospital stay. Risk factors are younger age, longer aortic cross-clamping/bypass times, and intraoperative arrhythmias.
Collapse
Affiliation(s)
- Corinna Paluszek
- 1 Department of Pediatric and Congenital Heart Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Paolo Brenner
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Maximilian Pichlmaier
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Nikolaus A Haas
- 3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Robert Dalla-Pozza
- 3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Christian Hagl
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Lale Hakami
- 1 Department of Pediatric and Congenital Heart Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| |
Collapse
|
10
|
Jain A, Alam S, Viralam SK, Sharique T, Kapoor S. Incidence, Risk Factors, and Outcome of Cardiac Arrhythmia Postcardiac Surgery in Children. Heart Views 2019; 20:47-52. [PMID: 31462958 PMCID: PMC6686607 DOI: 10.4103/heartviews.heartviews_88_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective To study the incidence of postoperative cardiac arrhythmias in children undergoing cardiac surgery and to evaluate the risk factors and outcome of these patients. Materials and Methods This retrospective observational study was conducted in the cardiac pediatric intensive care unit and included children <18 years of age. Children were monitored in the early postoperative period (72 h) for any sustained rhythm abnormality and were classified using standard definition. Details of treatment and their response were assessed. Risk factors for arrhythmias were evaluated using multivariate logistic regression analysis. Results Five hundred and thirty-six children were included and the prevalence of arrhythmia was 14.4% (n = 77). The most common arrhythmia was complete heart block (CHB) (n = 28; 5.2%), followed by junctional ectopic tachycardia (JET) (n = 25; 4.7%), junctional escape rhythm (n = 13; 2.4%), supraventricular tachycardia (SVT) (n = 8; 1.5%), and ventricular tachycardia (VT) (n = 3; 0.6%). Cardiac pacing was required in all CHB; 8 (28.6%) required a permanent pacemaker. Six (24%) patients with JET responded to conventional measures; 19 (76.0%) patients required amiodarone and 5 (20%) required cooling to 34°C or cardiac pacing. Temporary cardiac pacing was required in 9 (69.2%) cases of junctional escape rhythm. Seven (87.5%) events of SVT responded to adenosine and 1 (12.5%) required cardioversion. Two (66.7%) of VT responded to cardioversion while 1 (33.3%) was refractory. Five (6.5%) patients with arrhythmia died. In the multivariate logistic regression analysis, age <1 year, risk adjustment for congenital heart surgery category ≥3, and cross-clamp time >67 min were independent risk factors. Conclusion Early postoperative period following cardiac surgery is extremely vulnerable to cardiac arrhythmias. Although majority are self-limiting, some can be life-threatening.
Collapse
Affiliation(s)
- Akanksha Jain
- Pediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, UK
| | - Shahzad Alam
- Department of Akanksha, Pediatric Cardiac Evaluation and Cardiac Surgery Unit, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
| | - S Kiran Viralam
- Department of Pediatric Cardiology, Narayana Health, Bengaluru, Karnataka, India
| | - Tanzila Sharique
- Department of Pediatrics, Narayana Health, Bengaluru, Karnataka, India
| | - Saurabh Kapoor
- Department of Pediatrics, Narayana Health, Bengaluru, Karnataka, India
| |
Collapse
|