Acute and Critical Care

Original Article

Pediatrics
Early postoperative arrhythmias after pediatric congenital heart disease surgery: a 5-year audit from a lower- to middle-income country: Sidra Ishaque, Saleem Akhtar, Asma Akbar Ladak, Russell Seth Martins, Muhammad Kamran Younis Memon, Alisha Raza Kazmi, Fatima Mahmood, Anwar ul Haque; Acute Crit Care. 2022;37(2):217-223. Published online February 3, 2022; DOI: https://doi.org/10.4266/acc.2020.00990

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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.

Citations

Citations to this article as recorded by

Prevalence and risk factors analysis of early postoperative arrhythmia after congenital heart surgery in pediatric patients
Ketut Putu Yasa, Arinda Agung Katritama, I. Komang Adhi Parama Harta, I. Wayan Sudarma
Journal of Arrhythmia.2024; 40(2): 356. CrossRef
Improvements in Accuracy and Confidence in Rhythm Identification After Cardiac Surgery Using the AtriAmp Signals
Diane H. Brown, Xiao Zhang, Awni M. Al-Subu, Nicholas H. Von Bergen
Journal of Intensive Care Medicine.2023; 38(9): 809. CrossRef

Case Report

Cardiology
Two women presenting aborted sudden cardiac arrest as the first event of mitral valve disease: Sua Kim, Jae Min Shim, Seong-Mi Park; Acute Crit Care. 2019;34(4):289-293. Published online November 13, 2018; DOI: https://doi.org/10.4266/acc.2017.00570

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Abstract PDF

Mitral valve prolapse (MVP) is a relatively common valvular heart disease and is known to have a benign course. However, a certain subtype of MVP has a pathologic prognosis and can be accompanied by malignant cardiac arrhythmia causing sudden cardiac arrest, which can be characterized by bileaflet mitral valvular thickening and prolapse and frequent premature ventricular ectopic activity upon electrocardiography. Herein, we present two patients with bileaflet mitral prolapse who survived aborted sudden cardiac arrest. These cases show a precise MVP diagnosis that may prevent a devastating life event with the unique MVP subtype.

Citations

Citations to this article as recorded by

Mitral annular disjunction identified peripartum: A case highlighting key features of a recently classified syndrome
Monique Doran, Gemma Reemst, Kenny Ng, Courtney Shaw, Paul Stoodley
Sonography.2023; 10(1): 30. CrossRef

Original Article

Metabolic Syndrome as a Risk Factor for Atrial Fibrillation in Patients with Acute Myocardial Infarction: Woo Seung Shin, Mi Youn Park, You Mi Hwang, Hui Kyung Jeon, Man Young Lee, Jong Min Lee, Byoung Joo Shim, Sung Sik Kim, Seung Jae Lee, Yong Seog Oh, Tai Ho Rho, Ki Bae Seung; Korean J Crit Care Med. 2011;26(1):6-12.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.6

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Abstract PDF

BACKGROUND
Atrial fibrillation (AF) has been linked to an increased risk for in-hospital and long-term mortality rates in patients with acute myocardial infarction (AMI). Obesity and metabolic syndrome (MS) are known to play an important role in cardiovascular morbidity and mortality. However, it is uncertain whether obesity and MS increase the risk of AF in patients with AMI. Therefore, we investigated independent risk factors for the occurrence of new-onset AF in patients with AMI who received optimal percutaneous coronary intervention (PCI).
METHODS
We prospectively analyzed the association between MS and the incidence of cardiac arrhythmia in 146 patients with AMI who underwent PCI. Twenty-four-hour Holter monitoring was performed 3 days after AMI. We divided the patients into two different groups based on the development of AF and analysed their obesity based on body mass index (BMI) (kg/m2) and evaluated the existence of MS, as well as visceral obesity with fat computed tomography.
RESULTS
Seventy-five patients (51.4%) were obese (BMI > or = 25) and 64 (44%) had MS. AF occurred in 33 (22.6%) patients. Age, MS, and visceral obesity were significantly associated with AF (p = 0.001, p = 0.003, and p = 0.03, respectively). There was no difference between obese and non-obese patients in the incidence of AF and VT. Multivariate analysis revealed that age and MS were independent risk factors of post-AMI AF.
CONCLUSIONS
MS is an important and modifiable risk factor for new-onset AF especially in patients with AMI who underwent PCI.

Citations

Citations to this article as recorded by

Impact of Metabolic Syndrome on Procedural Outcomes in Patients With Atrial Fibrillation Undergoing Catheter Ablation
Sanghamitra Mohanty, Prasant Mohanty, Luigi Di Biase, Rong Bai, Agnes Pump, Pasquale Santangeli, David Burkhardt, Joseph G. Gallinghouse, Rodney Horton, Javier E. Sanchez, Shane Bailey, Jason Zagrodzky, Andrea Natale
Journal of the American College of Cardiology.2012; 59(14): 1295. CrossRef

Case Report

Topical Epinephrine-soaked Gauze-induced Ventricular Tachycardia during Skin Grafting: A Case Report: Jongyeon Lee, Hyeonjeong Yang, Mingu Kim, Hyunjue Gill, Kuemhee Chung, Sunghee Chung, Jieun Song, Sangwoo Lee; Korean J Crit Care Med. 2009;24(1):42-46.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.42

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Abstract PDF

Topical epinephrine is useful to reduce bleeding during skin grafting. However, even though a clear operative field is obtained, systemic absorption of topical epinephrine can occur and this may cause severe hypertension, arrhythmias, ventricular tachycardia, myocardial ischemia, pulmonary edema, or cardiac arrest. We managed a case of cardiac arrhythmia during general anesthesia, which was induced by gauze soaked in topical epinephrine used for skin grafting of burn wounds. A 26-year-old woman developed premature ventricular complexes and ventricular tachycardia during surgery when epinephrine-soaked gauze was applied to the skin donor and burn wound sites to control oozing. The patient was resuscitated immediately and within 10 minutes the vital signs had normalized. It is recommended that caution is exercised when epinephrine-soaked gauze is applied to a large area of skin.

Citations

Citations to this article as recorded by

Ventricular Fibrillation Soon after Endobronchial Epinephrine Application in a Young Man -A Case Report-
Young Min Shin, Jong Hyung Kim, Hyung Wook Kim, Bo Sik Choi, Jin-Gyu Jeong, Jung Won Hwang, Kwang Won Seo, Jong-Joon Ahn, Seung Won Ra
The Korean Journal of Critical Care Medicine.2011; 26(4): 276. CrossRef

Original Article

Nonlinear Analysis of Heart Rate Variability: Possible Predictor for Atrial Fibrillation after Coronary Artery Bypass Graft (CABG) Surgery: Kyung Sil Im, Jong Bun Kim, Jae Myeong Lee, Kuhn Park, Hyun Ju Jung, Jeong Yun Rhee; Korean J Crit Care Med. 2007;22(1):25-29.

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Abstract PDF: BACKGROUND
Heart Rate Variability (HRV) is a valuable marker of autonomic tone and may assist evaluating the prognosis in patients with heart disease. The purpose of this study was to assess whether preoperative heart rate variability analysis predicts atrial fibrillation in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: This study was designed as a prospective observational study. After IRB approval was obtained by our institution, 76 patients scheduled for elective CABG surgery underwent a 10-min electrocardiogram recordings 1~2 hours prior to surgery. Heart rate variability analysis was performed with spectral analysis and point correlation dimension. RESULTS: There was no significant difference in the low and high frequency component (LF/HF) ratio preoperatively between patients with atrial fibrillation and patients with normal sinus rhythm postoperatively (3.0+/-2.45, 4.25+/-3.70, p=0.085). Baseline peak point correlation dimension (pPD2) was significantly higher in patients with atrial fibrillation than in patients with normal sinus rhythm postoperatively (4.2+/-0.8, 3.8+/-0.7, p=0.042). CONCLUSIONS: Patients who developed atrial fibrillation postoperatively had a higher baseline pPD2 value preoperatively. Point correlation dimensions may predict the occurrence of postoperative atrial fibrillation after CABG surgery. However, further studies are needed to confirm whether point correlation dimensions are an effective predictor for postoperative atrial fibrillation.

Case Report

Pharmacological Cardioversion with Phenylephrine for Paroxysmal Supraventricular Tachycardia during Lung Resection Surgery: A Case Report: Hyun Jung Kim, Soo Kyung Lee, Young Mi Kim, Hyun Soo Moon; Korean J Crit Care Med. 2006;21(1):57-62.

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Abstract PDF: Supraventricular arrhythmias during and after thoracotomy for pulmonary resections are well documented, and risk factors of post-pulmonary resection arrhythmias are old age, magnitude of surgery, and coexisting cardiopulmonary disease etc. Among of supraventricular arrhythmias, atrial fibrillation is the most common rhythm disturbance that may be associated with increased morbidity and mortality. We experienced a case of paroxysmal supraventricular tachycardia with severe hypotension which was escalated from atrial fibrillation during pulmonary bilobectomy for tuberculosis in a 44-year old male patient. Instead of usual electrical cardioversion or common antiarrhythmic agents, we selected phenylephrine bolus injection which induced normal sinus rhythm successfully from paroxysmal supraventricular tachycardia of the patient.

Review

The Diagnosis and Pharmacologic Management of Arrhythmia: Heon Kil Lim; Korean J Crit Care Med. 2002;17(2):61-65.

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Abstract PDF: Arrhythmias are categorized as due to abnormal impulse formation, abnormal impulse propagation or combined abnormalities of impulse formation and propagation. The primary tools used in the diagnosis of cardiac arrhythmias are the history, physical examination,12-lead electrocardiogram,24-hour continuous electrocardiographic recording, exercise test,intermittent electrocardiographic recording and clinical electrophysiologic study. Optimal management of cardiac arrhythmias requires knowledge of their mechanism,etiology, natural history and effect on the hemodynamic state.And the antiarrhythmic treatment must be monitored closely for its initial and continued effectiveness and for adverse effects.

Case Report

Atrial Fibrillation Developed after Induction of General Anesthesia in an Elderly Patient: A case report: Seok Ho Han, Jin Woo Choi; Korean J Crit Care Med. 1998;13(2):261-261.

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Abstract PDF: It is known that the incidence of arrhythmia related to anesthesia and operation is significantly higher in thoracic surgery such as cardiac, lung operation than any other operation, and atrial fibrillation is the most common arrhythmia among these arrhythmias. Besides operative sites, age and underlying cardiac problem such as hypertension, cardiomegaly can be important risk factors for intra, post-operative atrial fibrillation in non-thoracic surgery. Through many investigations, we can find that age is the most important because age related anatomical, physiological cardiac changes make elderly patients more susceptible to development of atrial fibrillation. In this case, we report atrial fibrillation that occurred after induction of general anesthesia in an elderly patient undergoing open reduction of upper arm fracture.

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