Incidence and Recovery of Postsurgical Heart Block in Pediatric Patients
Following Cardiac Surgery for Congenital Heart Disease
Abstract
Introduction: A subset of patients who develop post-surgical heart block
have recovery of atrioventricular-node function. Factors predicting
recovery are not understood. We sought to investigate our center’s
incidence of post-surgical heart block and examine factors associated
with recovery of atrioventricular-node function. Methods: Patients 0 –
21 years who underwent cardiac surgery between January 2010 – December
2019 at a free-standing children’s hospital and experienced
postoperative heart block were included. Demographics, clinical and
operative variables were analyzed. Results: Of 6333 surgical
hospitalizations, 128 (2%) patients were included. Of the 128 patients
included, 90 (70%) had return of atrioventricular-node function, and 38
(30%) had permanent 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
to from onset of heart block to late atrioventricular-node recovery was
13 days (IQR 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
postoperative steroids was similar between all groups ( p = 0.445).
Infectious or wound complications were similar between pacemaker groups
( p = 1). Conclusions: Two percent of patients who underwent cardiac
surgery developed postoperative heart block, and 0.6% underwent
pacemaker placement. Early recovery of atrioventricular-node was
associated with greater weight at 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.