Arrhythmias Developing in Pediatric Patients After Cardiac Surgery: A Comprehensive Review on the Risk Factors, Prevention and Management Strategies

The most common complications post pediatric cardiac surgeries are postoperative arrhythmias. They greatly influence adverse postoperative events, duration of stay in intensive care unit (ICU), and patient outcome [1] [2]. Regardless of surgical advancements, perioperative care and pain management, the rate of arrhythmias in current patient populations is significant [2] [3]. This narrative review aims to investigate the risk factors of postoperative arrhythmias in pediatric cardiac surgery, highlight preventive strategies that are evidence-based and give an overview of prevalent management techniques. Risk factors attributable to arrhythmogenesis are patient oriented or pertain to surgical specificities. Patient-related risks include age, prior cardiac abnormalities and electrolytic irregularities. Surgical risks encompass the type of procedure performed, time period undertaken for cardiopulmonary bypass procedures, and intraoperative myocardial ischemia [1] [2]. Preventive strategies involve conscientious perioperative monitoring, rectifying metabolic abnormalities, defensive approaches for the myocardium, and utilising prophylactic antiarrhythmic pharmacotherapy in high-risk patients. Continual electrocardiographic monitoring is an effective means of early diagnosis, aiding in diminishing advancements of arrhythmias to hemodynamic damage [3]. Several types of arrhythmia require distinct therapeutic techniques. Therapeutic strategies range from pharmacotherapy with amidarone, to using pacemakers. Perioperative protocol developments, better intraoperative monitoring technologies, and advancing pharmacotherapy, showcase promise in improving preventive and management methods. Research in longevity and durability of the studies is required, along with multicenter collaborations to produce uniform protocols and predictive prototypes customised for the Pediatric population. Future directions emphasise on refining risk prediction tools, assessing new therapies, and incorporating biomarker- based risk stratification into clinical practice. Providing current evidence and focusing on blind spots, makes this review beneficial for clinicians and researchers, with practical comprehension for better discernment, encouraging further research in Pediatric cardiac care.