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Postoperative Atrioventricular Block in Pediatric Patients: Impact of Congenital Cardiac Malformations and Medications

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Abstract

Postoperative atrioventricular block may occur after pediatric cardiac surgery. A small proportion of those who develop atrioventricular block will require pacemaker placement. The primary aim of this study was to determine factors associated with postoperative atrioventricular block. Secondary aims included determining factors associated with pacemaker placement in those with atrioventricular block. Data from the PHIS data were utilized to identify patients under 18 years of age who underwent cardiac surgery. Those who did and did not develop atrioventricular block. Univariable analyses and regression analyses were conducted to determine factors associated with postoperative atrioventricular block. Similar analyses were conducted to determine factors associated with pacemaker placement in those with atrioventricular block. A total of 43,716 admissions were identified. Of these, 2093 (5%) developed atrioventricular block and 480 (1% of total admissions) underwent pacemaker placement. Approximately 70% of those with atrioventricular block received steroids but this was not associated with a decrease in pacemaker placement. Risk factors (congenital malformations of the heart, comorbidities, medications) associated with increased risk of atrioventricular block and pacemaker placement were identified. Postoperative atrioventricular block occurred in 5% of pediatric admissions for cardiac surgery. Of these admissions with postoperative atrioventricular block, 23% required pacemaker placement. Isoproterenol and steroids were not associated with a reduction in the likelihood of pacemaker placement.

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No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. Advocate Children’s Hospital, Chicago, IL, USA

    Rohit S. Loomba

  2. Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA

    Rohit S. Loomba

  3. Cohen Children’s Medical Center, New York, NY, USA

    Jacqueline Rausa

  4. Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico

    Enrique Villarreal

  5. Children’s Mercy Hospital, Kansas City, MO, USA

    Juan S. Farias

  6. Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA

    Saul Flores

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  1. Rohit S. Loomba
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  2. Jacqueline Rausa
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  3. Enrique Villarreal
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  4. Juan S. Farias
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  5. Saul Flores
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Contributions

RL- study design, data preparation, data analysis, manuscript preparation, manuscript review JP- study design, manuscript preparation, manuscript review EV- study design, manuscript preparation, manuscript review JF- study design, manuscript preparation, manuscript review SF- study design, data procurement, manuscript preparation, manuscript review

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Correspondence to Rohit S. Loomba.

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Loomba, R.S., Rausa, J., Villarreal, E. et al. Postoperative Atrioventricular Block in Pediatric Patients: Impact of Congenital Cardiac Malformations and Medications. Pediatr Cardiol 45, 759–769 (2024). https://doi.org/10.1007/s00246-024-03427-7

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  • DOI: https://doi.org/10.1007/s00246-024-03427-7

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