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\begin{document}

\title{Incidence and Recovery of Postsurgical Heart Block in Pediatric Patients
Following Cardiac Surgery for Congenital Heart Disease}



\author[1]{Rohit Madani}%
\author[1]{Elizabeth Aronoff}%
\author[2]{Jessica Posey}%
\author[2]{Mohua Basu}%
\author[2]{Tawanda Zinyandu}%
\author[1]{Paul Chai}%
\author[3]{Robert Whitehill}%
\author[1]{Kevin Maher}%
\author[1]{Asaad Beshish}%
\affil[1]{Emory University School of Medicine}%
\affil[2]{Children's Healthcare of Atlanta at Egleston}%
\affil[3]{Children's Healthcare of Atlanta Inc}%


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  \date{May 25, 2024}


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\begin{abstract}
Introduction: A subset of patients who develop post-surgical heart block
have recovery of atrioventricular-node function. Factors predicting
recovery are not understood. We sought to investigate our center's
incidence of post-surgical heart block and examine factors associated
with recovery of atrioventricular-node function. Methods: Patients 0 --
21 years who underwent cardiac surgery between January 2010 -- December
2019 at a free-standing children's hospital and experienced
postoperative heart block were included. Demographics, clinical and
operative variables were analyzed. Results: Of 6333 surgical
hospitalizations, 128 (2\%) patients were included. Of the 128 patients
included, 90 (70\%) had return of atrioventricular-node function, and 38
(30\%) had permanent pacemaker placement. Of the 38 patients who
underwent pacemaker placement, 6 (15.8\%) had recovery of
atrioventricular-node function noted on long-term follow-up. Median time
to from onset of heart block to late atrioventricular-node recovery was
13 days (IQR 5 -- 117). Patients with single-ventricle physiology ( p =
0.04), greater weight ( p = 0.03) and shorter cardiopulmonary bypass
time ( p =0.015) were more likely to have recovery. The use of
postoperative steroids was similar between all groups ( p = 0.445).
Infectious or wound complications were similar between pacemaker groups
( p = 1). Conclusions: Two percent of patients who underwent cardiac
surgery developed postoperative heart block, and 0.6\% underwent
pacemaker placement. Early recovery of atrioventricular-node was
associated with greater weight at time of surgery, single-ventricle
physiology and shorter cardiopulmonary bypass time. Late recovery of
atrioventricular-node conduction following pacemaker placement occurred
in 15.8\% of patients.%
\end{abstract}%



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