Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-05T03:16:12.583Z Has data issue: false hasContentIssue false
  • English
  • Français

Arrhythmias in the paediatric intensive care unit: a prospective study of the rates and predictors of arrhythmias in children without underlying cardiac disease

Published online by Cambridge University Press:  01 December 2014

Gina N. Cassel-Choudhury ,
Scott I. Aydin ,
Iris Toedt-Pingel ,
H. Michael Ushay ,
James S. Killinger ,
Hillel W. Cohen  and
Scott R. Ceresnak
Gina N. Cassel-Choudhury*
Affiliation:
Department of Pediatrics, Division of Critical Care, The Children’s Hospital at Montefiore, New York, United States of America
Scott I. Aydin
Affiliation:
Department of Pediatrics, Division of Cardiology, The Children’s Hospital at Montefiore, New York, United States of America
Iris Toedt-Pingel
Affiliation:
Department of Pediatrics, Division of Critical Care, The Children’s Hospital at Montefiore, New York, United States of America
H. Michael Ushay
Affiliation:
Department of Pediatrics, Division of Critical Care, The Children’s Hospital at Montefiore, New York, United States of America
James S. Killinger
Affiliation:
Department of Pediatrics, Division of Critical Care, The Children’s Hospital at Montefiore, New York, United States of America
Hillel W. Cohen
Affiliation:
Department of Epidemiology and Biostatistics, Albert Einstein College of Medicine, New York, United States of America
Scott R. Ceresnak
Affiliation:
Department of Pediatrics, Division of Cardiology, The Children’s Hospital at Montefiore, New York, United States of America
*
Correspondence to: G. N. Cassel, Department of Pediatrics, Division of Critical Care, The Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Rosenthal 4, Bronx, NY 10467, United States of America. Tel: (516) 521-7597; Fax: (718) 654-6692; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Arrhythmias are common in patients admitted to the paediatric intensive care unit. We sought to identify the rates of occurrence and types of arrhythmias, and determine whether an arrhythmia was associated with illness severity and paediatric intensive care unit length of stay.

Design

This is a prospective, observational study of all patients admitted to the paediatric intensive care unit at the Children’s Hospital at Montefiore from March to June 2012. Patients with cardiac disease or admitted for the treatment of primary arrhythmias were excluded. Clinical and laboratory data were collected and telemetry was reviewed daily. Tachyarrhythmias were identified as supraventricular tachycardia, ventricular tachycardia, and arrhythmias causing haemodynamic compromise or for which an intervention was performed.

Results

A total of 278 patients met the inclusion criteria and were analysed. There were 97 incidences of arrhythmia in 53 patients (19%) and six tachyarrhythmias (2%). The most common types of arrhythmias were junctional rhythm (38%), premature atrial contractions (24%), and premature ventricular contractions (22%). Tachyarrhythmias included three supraventricular tachycardia (50%) and three ventricular tachycardia (50%). Of the six tachyarrhythmias, four were related to placement or migration of central venous lines and two occurred during aminophylline infusion. Patients with an arrhythmia had longer duration of mechanical ventilation and paediatric intensive care unit stay (p<0.001). In multivariate analysis, central venous lines (odds ratio 3.1; 95% confidence interval 1.3–7.2, p=0.009) and aminophylline use (odds ratio 5.1; 95% confidence interval 1.7–14.9, p=0.003) were independent predictors for arrhythmias.

Conclusions

Arrhythmias were common in paediatric intensive care unit patients (19%), although tachyarrhythmias occurred rarely (2%). Central venous lines and use of aminophylline were identified as two clinical factors that may be associated with development of an arrhythmia.

Keywords

Arrhythmiaschildrenintensive care unitcentral venous lineaminophylline
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 7 , October 2015 , pp. 1281 - 1289
Check for updates
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Goodman, S, Shirov, T, Weissman, C. Supraventricular arrhythmias in intensive care unit patients: short and long-term consequences. Anesth Analg 2006; 104: 880–886.Google Scholar
2. Reinelt, P, Karth, GD, Geppert, A, Heinz, G. Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU. Intensive Care Med 2001; 27: 1466–1473.Google Scholar
3. Tarditi, DJ, Hollenberg, SM. Cardiac arrhythmias in the intensive care unit. Semin Respir Crit Care Med 2006; 27: 221–229.Google Scholar
4. Goldman, L. Supraventricular tachyarrhythmias in hospitalized adults after surgery. Clinical correlates in patients over 40 years of age after major noncardiac surgery. Chest 1978; 73: 450–454.Google Scholar
5. Kirkpatrick, JR, Heilbrunn, A, Sankaran, S. Cardiac arrhythmias: an early sign of sepsis. Am Surg 1973; 39: 380–382.Google Scholar
6. Knotzer, H, Mayr, A, Ulmer, H, et al. Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study. Intensive Care Med 2000; 26: 908–914.Google Scholar
7. Walsh, SR, Tang, T, Wijewardena, C, Yarham, SI, Boyle, JR, Gaunt, ME. Postoperative arrhythmias in general surgical patients. Ann R Coll Surg Engl 2007; 89: 91–95.Google Scholar
8. Hoffman, TM, Wernovsky, G, Wieand, TS, et al. The incidence of arrhythmias in a pediatric cardiac intensive care unit. Pediatr Cardiol 2002; 23: 598–604.Google Scholar
9. Polanczyk, CA, Goldman, L, Marcantonio, ER, Orav, EJ, Lee, TH. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med 1998; 129: 279–285.CrossRefGoogle ScholarPubMed
10. Bender, JS. Supraventricular tachyarrhythmias in the surgical intensive care unit: an under-recognized event. Am Surg 1996; 62: 73–75.Google Scholar
11. Brathwaite, D, Weissman, C. The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. Chest 1998; 114: 462–468.CrossRefGoogle ScholarPubMed
12. Slater, A, Shann, F, Pearson, G. Paediatric Index of Mortality Study G. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29: 278–285.Google Scholar
13. Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.Google Scholar
14. Hadjizacharia, P, O’Keeffe, T, Brown, CVR, et al. Incidence, risk factors, and outcomes for atrial arrhythmias in trauma patients. Am Surg 2011; 77: 634–639.CrossRefGoogle ScholarPubMed
15. Chung, MK, Martin, DO, Sprecher, D, et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2001; 104: 2886–2891.Google Scholar
16. Bobbio, A, Caporale, D, Internullo, E, et al. Postoperative outcome of patients undergoing lung resection presenting with new-onset atrial fibrillation managed by amiodarone or diltiazem. Eur J Cardiothorac Surg 2007; 31: 70–74.Google Scholar
17. Lin, E, Calvano, SE, Lowry, SF. Inflammatory cytokines and cell response in surgery. Surgery 2000; 127: 117–126.Google Scholar
18. Goodman, S, Weiss, Y, Weissman, C. Update on cardiac arrhythmias in the ICU. Curr Opin Crit Care 2008; 14: 549–554.Google Scholar
19. Badrawi, N, Hegazy, RA, Tokovic, E, Lotfy, W, Mahmoud, F, Aly, H. Arrhythmia in the neonatal intensive care unit. Pediatr Cardiol 2009; 30: 325–330.Google Scholar
20. Dubin, A. Arrhythmias in the newborn. Neoreviews 2000; 1: 146–151.Google Scholar
21. Rosman, EC, Blaufox, AD, Menco, A, Trope, R, Seiden, HS. What are we missing? Arrhythmia detection in the pediatric intensive care unit. J Pediatr 2013; 163: 511–514.Google Scholar
22. Rhodes, LA, Wernovsky, G, Keane, JF, et al. Arrhythmias and intracardiac conduction after the arterial switch operation. J Thorac Cardiovasc Surg 1995; 109: 303–310.Google Scholar
23. Ceresnak, SR, Pass, RH, Starc, TJ, et al. Predictors for hemodynamic improvement with temporary pacing after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2011; 141: 183–187.Google Scholar
24. da Silva, PSL, Waisberg, J. Induction of life-threatening supraventricular tachycardia during central venous catheter placement: an unusual complication. J Pediatr Surg 2010; 45: E13–E16.Google Scholar
25. Lee, TY, Sung, CS, Chu, YC, Liou, JT, Lui, PW. Incidence and risk factors of guidewire-induced arrhythmia during internal jugular venous catheterization: comparison of marked and plain J-wires. J Clin Anesth 1996; 8: 348–351.Google Scholar
26. Stuart, RK, Shikora, SA, Akerman, P, et al. Incidence of arrhythmia with central venous catheter insertion and exchange. JPEN J Parenter Enteral Nutr 1990; 14: 152–155.Google Scholar
27. Vesely, TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003; 14: 527–534.Google Scholar
28. Hendeles, L, Bighley, L, Richardson, RH, Hepler, CD, Carmichael, J. Frequent toxicity from IV aminophylline infusions in critically ill patients. 1977. Ann Pharmacother 2006; 40: 1417–1423.Google Scholar
29. Patel, AK, Skatrud, JB, Thomsen, JH. Cardiac arrhythmias due to oral aminophylline in patients with chronic obstructive pulmonary disease. Chest 1981; 80: 661–665.Google Scholar
30. Varriale, P, Ramaprasad, S. Aminophylline induced atrial fibrillation. Pacing Clin Electrophysiol 1993; 16: 1953–1955.Google Scholar
31. Axelrod, DM. Initial experience using aminophylline to improve renal dysfunction in the pediatric cardiovascular ICU. Pediatr Crit Care Med 2014; 15: 21–27.Google Scholar