Postoperative Arrhythmias after Surgery for Congenital Heart Defects

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Abstract
All patients who undergo cardiac surgery are at risk for the development of postoperative arryhthmias. Many of these arrhythmias are sudden, unexpected and life threatening. The highest incidance of these arrhythmias occurs after intra-atrial repair of d-transposition of the great arieries, the Fontan repair of single ventricles, and repair of tetralogy of fallot. The correction of specific defects predisposes patients to the development of specific arrhythmias. Supraven tricular arrhythmias, especially atrial flutter and sinus nodal dysfunction, occur most commonly in lesions requiring extensive intra-atrial surgery, such as intra-atrial repair of d-transposition of great arteries of Fontan repair of single ventricles with associated postoperative elevation of atrial pressure. Repairs of atrial septal defects are associated with similar arrhythmias. Sudden death occures most often in defects with long standing right ventrifular pressure of volume overload with resultant fibrosis and dysfunction. These conditions are noted most commonly after repair of tetralogy of fallot ventricular septal defects, and left ventricular outflow obstruction five to 10% of these patients experience sudden death. Atrioventricular conduction defects, especially complete heart block, occur with a 1–2% incidence after repair of ventricular septal defects, particularly canal type defects, or in association with l-transposition of the great arteries, farly repair, improvements in operative techniques and myocardial preservation, in addition to systematic follow-up and appropriate treatment of idenofied arrhythmias should minimize the effect of this serious postoperative problem.

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