Heart rhythm · 2026
Sinus node dysfunction after surgery for congenital heart disease: Incidence and impact on recovery.
СтатьяНазвание и аннотация: Перевод в очереди
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Meziab Omar, Pærregaard Maria M, Feins Eric, Kheir John, O'Leary Edward, Triedman John K, Walsh Edward P, Dionne Audrey
Аннотация
BACKGROUND: Sinus node dysfunction (SND) is a known complication after surgery for congenital heart disease; however, its postoperative course is not well characterized.
OBJECTIVE: This study aimed to describe the incidence of postoperative SND and its impact on postoperative outcomes.
METHODS: This was a retrospective study of children aged 0-18 years after cardiac surgery in 2013-2017. SND is defined as bradycardia for age, junctional escape rhythm, or use of postoperative atrial pacing for bradycardia. SND was subcategorized as either absolute SND (sinus bradycardia for age or junctional rhythm <100 beats/min) or relative SND (normal sinus rate with hemodynamic need for atrial pacing). Postoperative outcomes were compared in surgeries with no postoperative SND, absolute SND, and relative SND.
RESULTS: Of the 4571 surgeries (age 1 year; interquartile range 0.2-4.5), SND occurred in 786 surgeries (17.2%) (absolute 695; relative 91). Absolute SND was most common after surgery involving pulmonary veins (31%), mitral valve (27%), atrial baffle creation (27%), Glenn palliation (26%), and Fontan palliation (26%). Relative SND was most common after stage 1 palliation (10%). Most surgeries (89%) recovered from SND before discharge, with a median recovery time of 31.9 hours. Surgeries with SND had longer hospital and intensive care unit length of stay, longer time to extubation, and a higher incidence of major adverse cardiac events.
CONCLUSION: SND occurs in more than 25% of surgeries involving pulmonary veins, mitral valve, atrial baffle creation, and Glenn and Fontan palliation. Stage 1 palliation frequently requires pacing for hemodynamic needs. SND persists at discharge in 11% and is associated with worse postoperative outcomes. Permanent atrial pacing need was found in 2% of all surgeries with postoperative SND.
OBJECTIVE: This study aimed to describe the incidence of postoperative SND and its impact on postoperative outcomes.
METHODS: This was a retrospective study of children aged 0-18 years after cardiac surgery in 2013-2017. SND is defined as bradycardia for age, junctional escape rhythm, or use of postoperative atrial pacing for bradycardia. SND was subcategorized as either absolute SND (sinus bradycardia for age or junctional rhythm <100 beats/min) or relative SND (normal sinus rate with hemodynamic need for atrial pacing). Postoperative outcomes were compared in surgeries with no postoperative SND, absolute SND, and relative SND.
RESULTS: Of the 4571 surgeries (age 1 year; interquartile range 0.2-4.5), SND occurred in 786 surgeries (17.2%) (absolute 695; relative 91). Absolute SND was most common after surgery involving pulmonary veins (31%), mitral valve (27%), atrial baffle creation (27%), Glenn palliation (26%), and Fontan palliation (26%). Relative SND was most common after stage 1 palliation (10%). Most surgeries (89%) recovered from SND before discharge, with a median recovery time of 31.9 hours. Surgeries with SND had longer hospital and intensive care unit length of stay, longer time to extubation, and a higher incidence of major adverse cardiac events.
CONCLUSION: SND occurs in more than 25% of surgeries involving pulmonary veins, mitral valve, atrial baffle creation, and Glenn and Fontan palliation. Stage 1 palliation frequently requires pacing for hemodynamic needs. SND persists at discharge in 11% and is associated with worse postoperative outcomes. Permanent atrial pacing need was found in 2% of all surgeries with postoperative SND.