Elsevier

American Heart Journal

Volume 202, August 2018, Pages 1-4
American Heart Journal

Clinical Investigation
Analysis of clinical and candidate genetic risk factors for postoperative atrial tachycardia after congenital heart surgery in infants

https://doi.org/10.1016/j.ahj.2018.04.014Get rights and content

Abstract

Background

Atrial tachycardia (AT) after infant congenital heart disease (CHD) surgery is associated with increased mortality. Polymorphisms in PITX2 (rs2200733) and IL6 (rs1800795) are associated with postoperative atrial fibrillation in adults but have not been studied in CHD. The objective was to test the hypothesis that clinical factors and variants in PITX2 and IL6 are associated with postoperative AT in infants with CHD.

Methods

Infants (<1 year of age) undergoing CHD surgery between September 2007 and May 2016 were included. Subjects had daily assessment of telemetry and were genotyped for the 2 variants. Univariate and multivariate analyses were performed to test for factors independently associated with AT.

Results

Of 1,067 enrolled infants, 164 had postoperative AT (15.4%); 95 required treatment (8.9%). AT was associated with risk for extracorporeal membrane oxygenation, operative mortality, and longer duration of ventilation, as well as intensive care unit and hospital stays. PITX2 and IL6 genotypes were not associated with AT or AT requiring treatment. In multivariate analysis, use of 2 or more inotropes, age ≤ 28 days; Risk Adjusted classification for Congenital Heart Surgery, Version 1, score ≥ 3; and bypass time were all independently associated with AT. Factors independently associated with treated AT include use of 2 or more inotropes; age ≤ 28 days; and Risk Adjusted classification for Congenital Heart Surgery, Version 1, score ≥ 3.

Conclusion

AT occurs in 15% of infants after CHD surgery and is associated with increased morbidity and mortality. Risk factors include use of 2 or more inotropes, neonatal age, and higher surgical complexity score. We observed no association between common genetic variants in PITX2 and IL6 and AT in infants after CHD surgery.

Section snippets

Methods

This study used an ongoing observational cohort study of children enrolled at the time of cardiac surgery for CHD. Children <1 year of age and undergoing their first surgery for CHD at Monroe Carell Jr Children's Hospital at Vanderbilt between September 2007 and May 2016 who consented to the study were included. The Institutional Review Board at Vanderbilt University Medical Center approved this study. Written consent was obtained from parents or legal guardians. Patients whose parents or

Results

A total of 1,067 infants with a median age of 2 months (interquartile range 0.3-5.1) were included in our study. Characteristics of the entire study cohort are listed in Table I. Overall operative mortality was 6.3%, and median duration of ventilation, ICU stay, and hospital stay were 2, 6, and 11 days, respectively. A total of 167 patients (15.4%) developed AT at a median of 5 days postoperatively (interquartile range 2-8 days). Patients who developed AT were younger and had higher surgical

Discussion

In this cohort of more than 1,000 infants undergoing CHD surgery, we observed AT in 15.4% and identified a number of clinical risk factors independently associated with AT, including use of 2 or more inotropes, higher surgical complexity score, neonatal age at surgery, and cardiopulmonary bypass time. We also investigated 2 common genetic variants in PITX2 and IL6 which have been associated with postoperative AF in adults, but found no association with postoperative AT in infants. Patients with

Conclusions

In conclusion, AT occurs in 15% of infants after congenital heart surgery and is associated with increased morbidity and mortality. Risk factors for AT include use of 2 or more inotropes, neonatal age at surgery, and higher surgical complexity score. We found no association between common genetic variants in PITX2 and IL6 and AT in infants after congenital heart surgery.

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