# Arrhythmia Following Congenital Heart Disease Surgery in Oman: Incidence and risk factors – A prospective study

## TL;DR

A study in Oman found that 14.2% of children who had heart surgery developed arrhythmias, with junctional ectopic tachycardia being the most common type.

## Contribution

The study identifies prolonged cardiopulmonary bypass time and prior cardiac surgery as independent risk factors for postoperative arrhythmias in children with congenital heart disease.

## Key findings

- Junctional ectopic tachycardia was the most frequent arrhythmia (57.1%) following congenital heart disease surgery.
- Prolonged cardiopulmonary bypass time and a history of previous cardiac surgery were independent predictors of postoperative arrhythmias.
- Arrhythmia patterns were found to be specific to the type of heart defect and surgical procedure.

## Abstract

This study aimed to determine the incidence, outcomes and risk factors of arrhythmia in children undergoing congenital heart disease (CHD) surgery in Oman.

This prospective cohort study was conducted between 2023 and 2024 at the National Heart Centre, Muscat, Oman. Paediatric patients who underwent CHD surgery were included; those with preoperative arrhythmia or permanent pacemakers were excluded. Demographic, intraoperative and postoperative variables were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of postoperative arrhythmia.

A total of 346 patients were included in this study, of which 49 (14.2%, 95% confidence interval: 10.6–18.3%) developed postoperative arrhythmias. Junctional ectopic tachycardia (JET) was most frequent (57.1%), followed by atrioventricular block (20.4%) and supraventricular tachycardia (18.4%); 3 patients with complete heart block required permanent pacemaker implantation and 1 patient died after ventricular tachycardia. Patients with arrhythmia had significantly longer cardiopulmonary bypass (CPB; P = 0.005) and cross-clamp times (P = 0.040). On multivariate analysis, prolonged CPB time (P = 0.049) and a history of previous cardiac surgery (P = 0.041) were independent predictors. Arrhythmia patterns were lesion-specific: (1) JET after tetralogy of Fallot, atrioventricular septal defect (AVSD) and arterial switch repairs; (2) complete heart block after AVSD or inlet VSD repairs; and (3) atrial arrhythmias after atrial-level procedures.

Postoperative arrhythmias occurred in 14.2% of children after CHD surgery in Oman, with JET being the most common. Prolonged CPB duration and prior cardiac surgery independently predicted arrhythmia, emphasising the need for vigilant monitoring and targeted perioperative management in high-risk groups.