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

Abstract

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