Postoperative atrioventricular block in pediatric patients: impact of congenital cardiac malformations and medications

Postoperative atrioventricular block in pediatric patients: impact of congenital cardiac malformations and medications | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Postoperative atrioventricular block in pediatric patients: impact of congenital cardiac malformations and medications rohit loomba, Jacqueline Rausa, Enrique Villarreal, Juan S. Farias, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3632444/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Mar, 2024 Read the published version in Pediatric Cardiology → Version 1 posted 7 You are reading this latest preprint version Abstract Background Postoperative atrioventricular block may occur after pediatric cardiac surgery. A small proportion of those who develop atrioventricular block will require pacemaker placement. The primary aim of this study was to determine factors associated with postoperative atrioventricular block. Secondary aims included determining factors associated with pacemaker placement in those with atrioventricular block. Methods Data from the PHIS data was utilized to identify patients under 18 years of age who underwent cardiac surgery. Those who did and did not develop atrioventricular block. Univariable analyses and regression analyses were conducted to determine factors associated with postoperative atrioventricular block. Similar analyses were conducted to determine factors associated with pacemaker placement in those with atrioventricular block. Results A total of 43,716 admissions were identified. Of these, 2,093 (5%) developed atrioventricular block and 480 (1% of total admissions) underwent pacemaker placement. Approximately 70% of those with atrioventricular block received steroids but this was not associated with a decrease in pacemaker placement. Risk factors (congenital malformations of the heart, comorbidities, medications) associated with increased risk of atrioventricular block and pacemaker placement were identified. Conclusions Postoperative atrioventricular block occurred in 5% of pediatric admissions for cardiac surgery. Of these admissions with postoperative atrioventricular block, 23% required pacemaker placement. Isoproterenol and steroids were not associated with a reduction in the likelihood of pacemaker placement. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Atrioventricular block occurs in approximately 5% of children after cardiac surgery. Of those who develop atrioventricular block, approximately 25% will undergo pacemaker placement [ 1 , 2 ]. While pacemaker placement helps restore sinus rhythm, it is associated with long-term morbidity such as need for pacemaker generator changes, lead replacements, infection, and pacemaker associated arrhythmia [ 3 – 6 ]. Thus, a decision to place a pacemaker in these children should not be taken lightly. Few studies have examined the rates of postoperative atrioventricular block in children and have identified factors associated with atrioventricular block [ 2 , 7 – 14 ]. Previous studies have demonstrated that congenital malformations associated with a ventricular septal defect, such as double outlet right ventricle and atrioventricular septal defect, are associated with atrioventricular heart block [ 2 , 10 , 12 , 14 , 15 ]. Additionally, left ventricular outflow tract obstruction and discordant atrioventricular connections, such as in congenitally corrected transposition, have been shown to have increased rate of atrioventricular heart block [ 14 ]. Previous studies have also explored the amount of time from the onset of atrioventricular block to restoration of sinus rhythm or pacemaker placement with resolution of atrioventricular block usually occurring within 10 days. Most of these previous studies were single center studies. The primary aim of this study was to utilize a multicenter database to determine factors associated with postoperative atrioventricular block. Methods Aims The primary aim of this study was to determine factors associated with postoperative atrioventricular block. Secondary aims included determining factors associated with pacemaker placement in those with atrioventricular block. Ethical considerations This study is in concordance with the Helsinki declaration. Although all data are publicly available and deidentified, institutional review board approval was received November 22, 2021 at Texas Children's Hospital (protocol H-42889), as this was the institution where the data were retrieved. PHIS database Data for this study were obtained from the Pediatric Health Information System (PHIS) database. PHIS is an administrative and billing database that contains inpatient, emergency department, ambulatory surgery, and observation data from not-for-profit, tertiary care pediatric hospitals in the United States. Data for this study was available from 46 hospitals that contribute data to PHIS and are affiliated with the Children’s Hospital Association (CHA, Lenexa, KS), a business alliance of children’s hospitals. Data quality and reliability are assured through a joint effort between CHA and participating hospitals. For the purposes of external benchmarking, participating hospitals provide discharge/encounter data including demographics, diagnoses, procedures, and charges. Data are deidentified at the time of data submission, and data are subjected to reliability and validity checks before inclusion in the database. Data selection and extraction Data from the PHIS database from 2016 to 2021 were utilized. This represents the most recent data that is available that utilizes ICD-10 codes. Intensive care unit admissions were identified utilizing the intensive care unit flag. Congenital heart disease was identified utilizing ICD-10 codes for various congenital malformations of the heart. Inclusion criteria for admissions utilized in the final analyses were: 1) pediatric admissions under 18 years of age; 2) cardiac surgery during the admission; 3) pre-operative length of stay of zero days such that a patient admission started with the operation so that it could be ensured that all interventions captured were postoperative. The presence of atrioventricular block was determined by querying the data for ICD-10 codes for first degree atrioventricular block, second degree atrioventricular block, and third-degree atrioventricular block to create a composite of these. Specific congenital malformations of the heart were identified using ICD-10 codes [ 16 , 17 ]. The presence of specific comorbidities, including but not limited to acute kidney injury, chronic kidney disease, acute hepatic insufficiency, and respiratory distress syndrome were similarly identified. Some comorbidities had a secondary effect of serving as severity of illness measures such as individual organ dysfunction, acidosis, need for mechanical ventilation, need for extracorporeal membrane oxygen, and cardiac arrest. Heart failure was a composite variable consisting of systolic and/or diastolic dysfunction of the left and/or right ventricle. Genetic anomaly was a composite variable consisting of any identified syndrome or genetic aberration that was coded. Administered medications were also identified. These included a large variety of medications used in the cardiac intensive care unit including vasoactive medications, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, sedative medications, antiarrhythmic medications, electrolytes, and nutritional supplements. Of specific interest to these analyses, a variety of glucocorticoids were collected which included dexamethasone, methylprednisolone, prednisolone, and hydrocortisone. The timing of when specific morbidities occurred in the admission relative to one another was not available. The timing of specific medications was also not available. Pacemaker implantation was a composite of all ICD-10 codes pertaining to pacemaker implantation. Statistical analyses The admissions found to meet inclusion criteria were divided into two groups: 1) those with atrioventricular block; and 2) those without atrioventricular block. Univariable comparisons were conducted with Mann-Whitney-U tests to compare continuous variables between groups and Fisher exact tests to compare descriptive variables between groups. Next, a series of regressions were conducted. The first was a logistic regression to model postoperative atrioventricular block. This was a backward likelihood ratio logistic regression with admission age in months, all cardiac diagnosis data, all medication data, and all comorbidity data included as independent variables. All postoperative admissions found to meet the inclusion criteria were entered into this regression. The aim of this regression was to determine factors associated with postoperative atrioventricular block. The second regression was a linear regression to model length of stay in only admissions with postoperative atrioventricular block. This was a stepwise linear regression with admission age in months, all cardiac diagnosis data, all medication data, all comorbidity data, and need for pacemaker implantation included as independent variables. The aim of this regression was to determine factors associated with length of stay in those with postoperative atrioventricular block with the primary question being the impact of steroids. The third regression was a logistic regression to model pacemaker implantation in only admissions with postoperative atrioventricular block. This was a backward likelihood ratio logistic regression with admission age in months, all cardiac diagnosis data, all medication data, and all comorbidity data included as independent variables. Next, a model was created to help characterize the probability of pacemaker implantation in those with postoperative atrioventricular block using the results from the logistic regression. This was done by including all significant variables found to be statistically significant and multiplying them by their beta coefficient. The products for all such significant independent variables and their beta coefficients were then summed. This resulted in what was then deemed the pacemaker risk score. A receiver operator curve analysis was then conducted to determine the accuracy of the pacemaker risk score in identifying patients who did undergo pacemaker implantation. Distance from a diagonal reference line as well as K-S statistics were utilized to determine an optimal cutoff. Sensitivity, specificity, positive predictive valve, and negative predictive value of the pacemaker risk score were then calculated using the cutoff value determined by the K-S statistics. Results Cohort information A total of 43,716 admissions were included in the analyses. Of these 43,716 admissions, 2,093 (5%) developed postoperative atrioventricular block. Of these, 2,093 admissions who developed atrioventricular block, 480 (23%) underwent pacemaker implantation (Fig. 1). Of the 2,093 postoperative admissions with atrioventricular block who ultimately underwent pacemaker implantation, 347 (72%) had received steroids. Of the 1,613 postoperative admissions with atrioventricular block who ultimately underwent pacemaker implantation, 1,121 (69%) had received steroids. The proportion of steroids in those with postoperative atrioventricular block who did or did not undergo pacemaker implantation was not statistically significantly different (Fig. 1). Congenital cardiac malformations and postoperative atrioventricular block The following cardiac malformations were associated with an increased likelihood of postoperative atrioventricular block by univariable analyses: double outlet right ventricle, transposition, double inlet left ventricle, discordant atrioventricular connections, isomerism, ventricular septal defect, atrioventricular septal defect, Ebstein anomaly, mitral stenosis, and subaortic stenosis. The following cardiac malformations were associated with a decreased likelihood of postoperative atrioventricular block: atrial septal defect, tricuspid stenosis, coarctation of the aorta, and double aortic arch (Table 1 ). Table 1 Cardiac diagnoses of those with and without postoperative atrioventricular block No atrioventricular block (n = 41,623) Atrioventricular block (n = 2,093) p-value Common arterial trunk 427 (1.0) 19 (0.9) 0.600 Double outlet right ventricle 2,690 (6.5) 233 (11.1) < 0.001 Double outlet left ventricle 72 (0.2) 7 (0.3) 0.090 Transposition 1,873 (4.5) 202 (9.7) < 0.001 Double inlet left ventricle 2,004 (4.8) 148 (7.1) < 0.001 Discordant atrioventricular connections 424 (1.0) 103 (4.9) < 0.001 Isomerism 210 (0.5) 18 (0.9) 0.028 Ventricular septal defect 11,330 (27.2) 743 (35.5) < 0.001 Atrial septal defect 20,279 (48.7) 853 (40.8) < 0.001 Atrioventricular septal defect 3,804 (9.1) 399 (19.1) < 0.001 Tetralogy of Fallot 2,809 (6.7) 138 (6.6) 0.780 Aortopulmonary septal defect 37 (0.1) 0 (0)_ 0.172 Pulmonary atresia 984 (2.4) 37 (1.8) 0.077 Pulmonary valve stenosis 1,372 (3.3) 74 (3.5) 0.550 Tricuspid stenosis 1,133 (2.7) 42 (2.0) 0.048 Ebstein anomaly 586 (1.4) 75 (3.6) < 0.001 Hypoplastic right heart syndrome 564 (1.4) 28 (1.3) 0.947 Aortic stenosis 773 (1.9) 50 (2.4) 0.081 Mitral stenosis 915 (2.2) 92 (4.4) < 0.001 Hypoplastic left heart syndrome 3,210 (7.7) 178 (8.5) 0.186 Divided atrium 144 (0.3) 11 (0.5) 0.177 Subaortic stenosis 1,385 (3.3) 154 (7.4) < 0.001 Coronary artery malformation 1,317 (41,623) 51 (2.4) 0.062 Coarctation of the aorta 2,479 (6.0) 100 (4.8) 0.026 Interruption of the aorta 260 (0.6) 19 (0.9) 0.112 Double aortic arch 597 (1.4) 4 (0.2) < 0.001 Right aortic arch 868 (2.1) 34 (1.6) 0.148 In cardiac malformations associated with an increased likelihood of postoperative atrioventricular block, the risk of postoperative atrioventricular block was as follows: 20% with discordant atrioventricular connections, 11% with Ebstein anomaly, 10% with subaortic stenosis, 10% with transposition, 9% with ventricular septal defect, 9% with mitral stenosis, 8% with isomerism, 8% with double outlet right ventricle, and 7% with double inlet left ventricle (Fig. 2). In cardiac malformations associated with an increased likelihood of pacemaker implantation for atrioventricular block, the risk of postoperative atrioventricular block was as follows: 39% with hypoplastic right heart syndrome, 39% with discordant atrioventricular connections, 39% with double inlet left ventricle, 35% with subaortic stenosis, and 33% with transposition (Fig. 3). Regression analysis of factors associated with postoperative atrioventricular block Table 2 outlines the variables statistically significantly associated with postoperative atrioventricular block. Older age, double outlet right ventricle, transposition, discordant atrioventricular connections, ventricular septal defect, atrioventricular septal defect, Ebstein anomaly, mitral stenosis subaortic stenosis, acute kidney injury, trisomy 21, extracorporeal membrane oxygenation, epinephrine, milrinone, carvedilol, propranolol, isoproterenol, enalapril, digoxin, amiodarone, procainamide, hydrocortisone, and methylprednisolone were all found to be associated with increased likelihood of postoperative atrioventricular block. Factors such as atrial septal defect, pulmonary atresia, tricuspid stenosis, coronary artery malformation, coarctation of the aorta, double aortic arch, total anomalous pulmonary venous connection, and atenolol were found to be associated with decreased likelihood of postoperative atrioventricular block. Table 2 Factors associated with postoperative atrioventricular block. Only statistically significant variables are included in the table. Beta coefficient p-value Odds ratio (95% confidence interval) Age (months) 0.003 < 0.001 1.003 (1.003 to 1.004) Double outlet right ventricle 0.270 < 0.001 1.310 (1.118 to 1.536) Transposition 0.480 < 0.001 1.616 (1.357 to 1.923) Discordant atrioventricular connections 1.334 < 0.001 3.796 (2.983 to 4.832) Ventricular septal defect 0.371 < 0.001 3.796 (2.983 to 4.832) Atrial septal defect -0.104 0.047 0.901 (0.814 to 0.999) Atrioventricular septal defect 0.481 < 0.001 1.618 (1.399 to 1.870) Pulmonary atresia -0.457 0.011 0.633 (0.446 to 0.899) Tricuspid stenosis -0.492 0.004 0.612 (0.439 to 0.852) Ebstein anomaly 0.699 < 0.001 2.012 (1.531 to 2.643) Mitral stenosis 0.453 < 0.001 1.575 (1.244 to 1.993) Subaortic stenosis 0.679 < 0.01 1.972 (1.631 to 2.385) Coronary artery malformation -0.440 0.004 0.644 (0.478 to 0.867) Coarctation of the aorta -0.318 0.006 0.728 (0.580 to 0.913) Double aortic arch -1.224 0.016 0.294 (0.109 to 0.797) Total anomalous pulmonary venous connection -0.495 0.011 0.610 (0.417 to 0.893) Acute kidney injury 0.189 0.025 1.208 (1.024 to 1.425) Trisomy 21 0.561 < 0.001 1.753 (1.499 to 2.050) Extracorporeal membrane oxygenation 0.336 0.002 1.400 (1.128 to 1.737) Epinephrine 0.344 < 0.001 1.410 (1.251 to 1.589) Milrinone 0.144 0.022 1.155 (1.021 to 1.306) Carvedilol 0.566 < 0.001 1.762 (1.338 to 2.320) Propranolol 0.227 0.036 1.255 (1.015 to 1.553) Atenolol -0.357 0.048 0.700 (0.491 to 0.998) Isoproterenol 1.911 < 0.001 6.761 (5.136 to 8.899) Enalapril 0.260 < 0.001 1.296 (1.149 to 1.463) Digoxin 0.256 0.004 1.292 (1.084 to 1.540) Amiodarone 0.569 < 0.001 1.766 (1.493 to 2.090) Procainamide 0.628 < 0.001 1.874 (1.421 to 2.471) Hydrocortisone 0.275 < 0.001 1.316 (1.143 to 1.515) Methylprednisolone 0.110 0.039 1.116 (1.005 to 1.238) It is important to keep in mind that these findings are not causal and are simply associations. This holds true for all the regression results. Thus, a finding such as epinephrine being associated with an increased likelihood of postoperative atrioventricular block may not represent a mechanism by which epinephrine caused atrioventricular block but rather may represent the fact that epinephrine was utilized after development of atrioventricular block for direct or indirect reasons. Regression analysis of factors associated with length of stay in those with postoperative atrioventricular block Table 3 outlines the variables statistically significantly associated with total length of stay in admissions with postoperative atrioventricular block. The beta-coefficient represents the number of days (either increase or decrease) in length of stay that the variable was associated with. The following factors were associated with increased length of stay: transposition, pulmonary valve stenosis, coarctation of the aorta, total anomalous pulmonary venous connection, acute kidney injury, infection, cardiac arrest, extracorporeal membrane oxygenation, epinephrine, norepinephrine, dopamine, dobutamine, isoproterenol, digoxin, and angiotensin converting enzyme inhibitor. Table 3 Regression results charactering factors associated with length of stay in those with postoperative atrioventricular block. Only statistically significant variables are included. Beta coefficient p-value Transposition 3.726 0.039 Pulmonary valve stenosis 6.866 0.012 Coarctation of the aorta 5.771 0.017 Total anomalous pulmonary venous connection 11.542 0.005 Genetic anomaly -2.825 0.046 Acute kidney injury 14.844 < 0.001 Infection 11.531 < 0.001 Cardiac arrest 7.098 0.013 Extracorporeal membrane oxygenation 6.565 0.002 Epinephrine 3.602 0.005 Norepinephrine 5.817 0.001 Dopamine 4.259 < 0.001 Dobutamine 11.061 0.003 Isoproterenol 7.218 0.002 Digoxin 11.251 < 0.001 Angiotensin converting enzyme inhibitor 4.047 < 0.001 Steroid 5.037 < 0.001 Of particular note, steroids did not decrease length of stay in those with postoperative atrioventricular block. Regression analysis of factors associated with pacemaker implantation in those with postoperative atrioventricular block Table 4 outlines the statistically significant variables associated with pacemaker implantation in admissions with postoperative atrioventricular block. Older age, double inlet left ventricle, discordant atrioventricular connections, isomerism, ventricular septal defect, subaortic stenosis, dopamine, isoproterenol, enalapril, lisinopril, dexamethasone, and liothyronine were associated with increased likelihood of pacemaker implantation in those with postoperative atrioventricular block. Atrial septal defect, sodium nitroprusside, digoxin, amiodarone, procainamide, and sildenafil were associated with a lower likelihood of pacemaker implantation in those with postoperative atrioventricular block. Table 4 Factors associated with pacemaker implantation in those with postoperative atrioventricular block. Only statistically significant variables are included in this table. Variable Beta coefficient p-value Odds ratio (95% confidence interval) Age (months) 0.002 < 0.001 1.002 (1.001 to 1.004) Double inlet left ventricle 0.259 0.017 1.662 (1.096 to 2.520) Discordant atrioventricular connections 0.561 0.020 1.753 (1.091 to 2.818) Isomerism 1.105 0.045 3.021 (1.005 to 9.549) Ventricular septal defect 0.308 0.022 1.361 (1.045 to 1.772) Atrial septal defect -0.544 < 0.001 0.581 (0.447 to 0.754) Subaortic stenosis 0.535 0.012 1.707 (1.125 to 2.583) Dopamine 0.261 0.038 1.299 (1.015 to 1.663) Isoproterenol 1.376 < 0.001 1.267 (0.814 to 1.973) Enalapril 0.560 < 0.001 1.751 (1.326 to 2.313) Lisinopril 0.725 0.002 2.066 (1.307 to 3.263) Chlorothiazide 0.393 0.005 1.481 (1.126 to 1.948) Sodium nitroprusside -0.380 0.013 0.684 (0.506 to 0.923) Digoxin -0.675 0.007 0.509 (0.310 to 0.835) Amiodarone -0.471 0.043 0.624 (0.395 to 0.985) Procainamide -1.205 0.007 0.300 (0.125 to 0.720) Sildenafil -0.590 0.010 0.555 (0.353 to 0.871) Dexamethasone 0.394 0.001 1.482 (1.168 to 1.880) Liothyronine 2.263 0.007 9.608 (1.843 to 50.081) Model performance for identifying admissions with postoperative atrioventricular block that get pacemaker implantation A model was created using the findings from the regression for pacemaker implantation in those with postoperative atrioventricular block. The median score was 0.35 in those who didn't have a pacemaker implanted and 0.91 in those who did. The resulting score had an area under the curve of 0.715 to identify those who underwent pacemaker implantation (Fig. 4). The optimal cutoff was 0.59. This had a sensitivity of 68%, specificity of 65%, positive predictive value of 36%, and negative predictive value of 87%. Thus, this score was able to identify with good ability, admissions with postoperative atrioventricular block that would not undergo pacemaker implantation but not those that would undergo pacemaker implantation. Overview of regression results Table 5 collates all statistically significant associations. Isoproterenol was associated with an increased likelihood of atrioventricular block, increased length of stay, and increased likelihood of pacemaker implantation. This is more likely the result of atrioventricular block wherein isoproterenol was started to try to restore sinus rhythm after the development of postoperative atrioventricular block. Enalapril was also associated with an increase in the likelihood of atrioventricular block, increase in length of stay in those who have postoperative atrioventricular block, and increase in the likelihood of pacemaker implantation. Table 5 Overview of significant findings from each regression Postoperative atrioventricular block Length of stay in those with atrioventricular block Pacemaker implantation in those with atrioventricular block Age (in months) Increased -- Increased Double outlet right ventricle Increased -- -- Double inlet left ventricle -- -- Increased Transposition Increased Increased -- Discordant atrioventricular connections Increased -- Increased Ventricular septal defect Increased -- Increased Atrial septal defect Decreased -- Decreased Atrioventricular septal defect Increased -- -- Pulmonary atresia Decreased -- -- Tricuspid stenosis Decreased -- -- Ebstein anomaly Increased -- -- Mitral stenosis Increased -- -- Pulmonary valve stenosis -- Increased -- Subaortic stenosis Increased -- Increased Coronary artery malformation Decreased -- -- Coarctation of the aorta Decreased Increased -- Double aortic arch Decreased -- -- Total anomalous pulmonary venous connection Decreased Increased -- Acute kidney injury Increased Increased -- Infection -- Increased -- Trisomy 21 Increased Decreased -- Cardiac arrest -- Increased -- Extracorporeal membrane oxygenation Increased Increased -- Epinephrine Increased Increased -- Norepinephrine -- Increased -- Dopamine -- Increased Increased Dobutamine -- Increased -- Milrinone Increased -- -- Carvedilol Increased -- -- Propranolol Increased -- -- Atenolol Decreased -- -- Isoproterenol Increased Increased Increased Enalapril Increased Increased Increased Digoxin Increased Increased Decreased Amiodarone Increased -- Decreased Procainamide Increased -- Decreased Hydrocortisone Increased -- -- Methylprednisolone Increased -- -- Dexamethasone -- -- Increased Older age, discordant atrioventricular connections, ventricular septal defect, and subaortic stenosis were associated with both an increased likelihood of postoperative atrioventricular block and increased likelihood of pacemaker implantation for the postoperative atrioventricular block. The discordant atrioventricular connections, ventricular septal defect, and subaortic stenosis being associated with increased atrioventricular block is likely due to the anatomic location of the conduction axis and its proximity to areas of repair in these hearts, particularly ventricular septal defect and subaortic stenosis. Digoxin, amiodarone, and procainamide were associated with increased likelihood of postoperative atrioventricular block and decreased likelihood of pacemaker implantation. This likely represents initiation of these medications and subsequent discontinuation in the setting of prolonged atrioventricular block, thus changing the direction of the association by the time of potential pacemaker implantation. Other malformations, comorbidities, and medications were associated with only a single one of the outcomes of interest. Subset analysis When the analyses were repeated including only those with third-degree atrioventricular block, factors associated with third-degree atrioventricular block did not significantly differ from all atrioventricular block. The rates of pacemaker placement were slightly higher in this subset. Regression results did not differ significantly either. Discussion This study utilizes data from the pediatric health information systems database to characterize postoperative atrioventricular block in pediatric patients undergoing cardiac surgery. Five percent of patients developed postoperative atrioventricular block and of those who developed postoperative atrioventricular block, 23% underwent pacemaker implantation. No medical intervention, such as isoproterenol or steroids, was associated with a decreased likelihood of pacemaker implantation in those who developed postoperative atrioventricular block. Steroids were administered to 70% of those with postoperative atrioventricular block. The proportion of postoperative patients who developed atrioventricular block in the current study is similar to what has been described in previous studies. Previous studies have reported rates of postoperative atrioventricular blocks from 1.4–11% [ 2 , 7 , 8 , 10 – 14 ]. The variability in the numbers exists due to specific subsets of patients that were included in some studies as well as what was defined as atrioventricular block. The current study included first, second-, and third-degree atrioventricular block as atrioventricular block while other studies only include second- and third-degree atrioventricular block or only third-degree atrioventricular block. Previous studies have reported rates of pacemaker placement in those with postoperative atrioventricular block between 31–49% [ 7 , 9 ]. The current study reports a rate of 23%, a figure likely lower than previous reports due to the inclusion of first-, second-, and third-degree atrioventricular block. Cardiac malformations associated with postoperative atrioventricular block in the current study were double outlet right ventricle, transposition, ventricular septal defect, atrioventricular septal defect, discordant atrioventricular connections, Ebstein anomaly, mitral stenosis, and subaortic stenosis. Double outlet right ventricle, ventricular septal defect, and atrioventricular septal defect are not surprising as a ventricular septal defect is found in all of the aforementioned malformations and often reside in close proximity to the conduction system, particularly the atrioventricular node and the proximal bundles. Such findings are consistent with previous reports [ 2 , 10 , 12 , 14 , 15 ]. Discordant atrioventricular connections, seen in congenitally corrected transposition, were also intuitively associated with postoperative atrioventricular block due to the known malformations in the conduction tissue [ 2 , 14 ]. Ebstein's anomaly was also found to be associated with atrioventricular block. Ebstein's has been described to have higher rates of atrioventricular block although this is generally first- or second-degree atrioventricular block and is hypothesized to be secondary to atrial dilation. Finally, subaortic stenosis was noted in the current study to be associated with atrioventricular block, consistent with previous studies. This association is also not particularly surprising, as the left bundle branch emerges on the left side in the left ventricular outflow tract and an intervention, specifically any removal of myocardium in this region, may lead to damage to the conduction tissues [ 2 , 8 , 14 ]. Some medications were found to be associated with increased likelihood of postoperative block such as epinephrine, milrinone, isoproterenol, digoxin, amiodarone, procainamide, hydrocortisone, and methylprednisolone. Agents such as epinephrine, milrinone, isoproterenol, hydrocortisone, and methylprednisolone were probably associated with atrioventricular block as they were started as a result of the atrioventricular block. For instance, steroids and isoproterenol may have been started to help try to restore sinus rhythm. Epinephrine may have been used similarly or to overcome impaired systemic oxygen delivery due to atrioventricular block. Agents such as digoxin, amiodarone, and procainamide have a less intuitive connection to atrioventricular block. It is possible that these agents were started after resolution of the atrioventricular block as the result of other arrhythmias or were started for some reason prior to the atrioventricular block and promoted it. With the data available in the database, it is not possible to fully delineate this association. Interestingly, the same congenital malformations of the heart that were associated with an increased likelihood of postoperative atrioventricular block were not necessarily the same congenital malformations that were associated with increased likelihood of pacemaker implantation once postoperative atrioventricular block developed. These malformations were double inlet left ventricle, discordant atrioventricular connections, ventricular septal defect, and subaortic stenosis. Many of these are associated with abnormal conduction tissues. Medications such as isoproterenol and dexamethasone were associated with an increased likelihood of pacemaker implantation and likely represent medications used to restore sinus rhythm. Some medications such as digoxin, amiodarone, and procainamide were associated with decreased likelihood of atrioventricular block but the association likely represents avoidance of these agents once postoperative atrioventricular block was present. This study could not necessarily determine duration of time to sinus rhythm recovery or pacemaker placement following atrioventricular block. Previous studies have demonstrated that those with atrioventricular block who had recovery of sinus rhythm mostly did so in the first week and rarely after 7 to 12 days [ 2 , 13 , 14 ]. These data represent the largest cohort from which data is derived to explore postoperative atrioventricular block in children undergoing cardiac surgery. Congenital malformations of the heart, comorbidities, and medications were all available in the database and their associations with atrioventricular block and pacemaker placement could be assessed. Despite the strengths of the study there are limitations. There is no data regarding the timing of any of the medications, atrioventricular block, or pacemaker placement. To try to overcome this, only admissions with no postoperative length of stay were included such that only admissions that started with the index operation were included. Thus, all the medications were administered after the operation, atrioventricular block developed after surgery and pacemakers placed were placed after the index operation. No details on medication dosage or duration were available in the database. Conclusion Postoperative atrioventricular block occurred in 5% of pediatric admissions for cardiac surgery. Of these admissions with postoperative atrioventricular block, 23% required pacemaker placement. Isoproterenol and steroids were not associated with a reduction in the likelihood of pacemaker placement. Declarations Author Contribution RL- study design, data preparation, data analysis, manuscript preparation, manuscript reviewJP- study design, manuscript preparation, manuscript reviewEV- study design, manuscript preparation, manuscript reviewJF- study design, manuscript preparation, manuscript reviewSF- study design, data procurement, manuscript preparation, manuscript review References Robinson JA, Leclair G, Escudero CA (2023) Pacing in Pediatric Patients with Postoperative Atrioventricular Block. Card Electrophysiol Clin 15:401–411 Romer AJ, Tabbutt S, Etheridge SP, Fischbach P, Ghanayem NS, Reddy VM, Sahulee R, Tanel RE, Tweddell JS, Gaies M, Banerjee M, Retzloff L, Zhang W, Patel AR (2019) Atrioventricular block after congenital heart surgery: Analysis from the Pediatric Cardiac Critical Care Consortium. J Thorac Cardiovasc Surg 157:1168–1177 e1162 Wilhelm BJ, Thone M, El-Scheich T, Livert D, Angelico R, Osswald B (2015) Complications and Risk Assessment of 25 Years in Pediatric Pacing. Ann Thorac Surg 100:147–153 Moak JP, Hasbani K, Ramwell C, Freedenberg V, Berger JT, DiRusso G, Callahan P (2006) Dilated cardiomyopathy following right ventricular pacing for AV block in young patients: resolution after upgrading to biventricular pacing systems. J Cardiovasc Electrophysiol 17:1068–1071 Kim JJ, Friedman RA, Eidem BW, Cannon BC, Arora G, Smith EO, Fenrich AL, Kertesz NJ (2007) Ventricular function and long-term pacing in children with congenital complete atrioventricular block. J Cardiovasc Electrophysiol 18:373–377 Gebauer RA, Tomek V, Salameh A, Marek J, Chaloupecky V, Gebauer R, Matejka T, Vojtovic P, Janousek J (2009) Predictors of left ventricular remodelling and failure in right ventricular pacing in the young. Eur Heart J 30:1097–1104 Ayyildiz P, Kasar T, Ozturk E, Ozyilmaz I, Tanidir IC, Guzeltas A, Ergul Y (2016) Evaluation of Permanent or Transient Complete Heart Block after Open Heart Surgery for Congenital Heart Disease. Pacing Clin Electrophysiol 39:160–165 Laredo M, Khraiche D, Raisky O, Gaudin R, Bajolle F, Maltret A, Chevret S, Bonnet D, Vouhe PR (2018) Long-term results of the modified Konno procedure in high-risk children with obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 156:2285–2294 e2282 Duong SQ, Shi Y, Giacone H, Navarre BM, Gal DB, Han B, Sganga D, Ma M, Reddy CD, Shin AY, Kwiatkowski DM, Dubin AM, Scheinker D, Algaze CA (2022) Criteria for Early Pacemaker Implantation in Patients With Postoperative Heart Block After Congenital Heart Surgery. Circ Arrhythm Electrophysiol 15:e011145 Siehr SL, Hanley FL, Reddy VM, Miyake CY, Dubin AM (2014) Incidence and risk factors of complete atrioventricular block after operative ventricular septal defect repair. Congenit Heart Dis 9:211–215 Ozturk E, Kafali HC, Tanidir IC, Tunca Sahin G, Onan IS, Haydin S, Guzeltas A, Ergul Y (2021) Early postoperative arrhythmias in patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg 29:27–35 Murray LE, Smith AH, Flack EC, Crum K, Owen J, Kannankeril PJ (2017) Genotypic and phenotypic predictors of complete heart block and recovery of conduction after surgical repair of congenital heart disease. Heart Rhythm 14:402–409 Aziz PF, Serwer GA, Bradley DJ, LaPage MJ, Hirsch JC, Bove EL, Ohye RG, Dick M 2nd (2013) Pattern of recovery for transient complete heart block after open heart surgery for congenital heart disease: duration alone predicts risk of late complete heart block. Pediatr Cardiol 34:999–1005 Weindling SN, Saul JP, Gamble WJ, Mayer JE, Wessel D, Walsh EP (1998) Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol 82:525–527 Di Mambro C, Calvieri C, Silvetti MS, Tamburri I, Giannico S, Baban A, Albanese S, Brancaccio G, Carotti A, Iorio FS, Drago F (2018) Bradyarrhythmias in Repaired Atrioventricular Septal Defects: Single-Center Experience Based on 34 Years of Follow-Up of 522 Patients. Pediatr Cardiol 39:1590–1597 Jacobs JP, Franklin RCG, Beland MJ, Spicer DE, Colan SD, Walters HL, Bailliard F, Houyel L, St Louis JD, Lopez L, Aiello VD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski BJ, Stellin G, Weinberg PM, Jacobs ML, Boris JR, Cohen MS, Everett AD, Giroud JM, Guleserian KJ, Hughes ML, Juraszek AL, Seslar SP, Shepard CW, Srivastava S, Cook AC, Crucean A, Hernandez LE, Loomba RS, Rogers LS, Sanders SP, Savla JJ, Tierney ESS, Tretter JT, Wang L, Elliott MJ, Mavroudis C, Tchervenkov CI (2021) Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). Cardiol Young 31:1057–1188 Jacobs JP, Franklin RCG, Beland MJ, Spicer DE, Colan SD, Walters HL 3rd, Bailliard F, Houyel L, St Louis JD, Lopez L, Aiello VD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski BJ, Stellin G, Weinberg PM, Jacobs ML, Boris JR, Cohen MS, Everett AD, Giroud JM, Guleserian KJ, Hughes ML, Juraszek AL, Seslar SP, Shepard CW, Srivastava S, Cook AC, Crucean A, Hernandez LE, Loomba RS, Rogers LS, Sanders SP, Savla JJ, Tierney ESS, Tretter JT, Wang L, Elliott MJ, Mavroudis C, Tchervenkov CI (2021) Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). World J Pediatr Congenit Heart Surg 12:E1–E18 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Mar, 2024 Read the published version in Pediatric Cardiology → Version 1 posted Editorial decision: Revision requested 04 Jan, 2024 Reviews received at journal 20 Nov, 2023 Reviewers agreed at journal 19 Nov, 2023 Reviewers invited by journal 19 Nov, 2023 Editor assigned by journal 19 Nov, 2023 Submission checks completed at journal 19 Nov, 2023 First submitted to journal 18 Nov, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3632444","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":250967223,"identity":"095d9830-6159-4103-a05b-609fbde0d57d","order_by":0,"name":"rohit loomba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYBACPiBmBrMkGBsYPgBpNnYCWtiQtDQ2zgCJMBOvhYGxmYcBzsWjhb356OaCGoZ8funm9sc2v7bJ8zEzMH74mINHC8+xtNszjjFYzpxzsLE5t++2YRszA7PkzG14tEjkmN3mYWMwMLiRCNTSc5sRqIWNmZegln9QLZY9t+2J08LbBtXC8ON2ImEtIL/M7JMwkJyR2Dizt+F2chszYzNev/CzNx+7XfDNxoBfIv3Bhx9/btvOb28++OEjHi1QIAGhGNvAZANB9UjgDymKR8EoGAWjYKQAAFw+S+97RZH3AAAAAElFTkSuQmCC","orcid":"","institution":"Advocate Children's Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"rohit","middleName":"","lastName":"loomba","suffix":""},{"id":250967224,"identity":"ef3fc4e0-34ff-4118-8f61-6cbc7c2793ab","order_by":1,"name":"Jacqueline Rausa","email":"","orcid":"","institution":"Cohen Children's Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jacqueline","middleName":"","lastName":"Rausa","suffix":""},{"id":250967225,"identity":"8a513140-34ee-476e-882f-8b40d3cfa627","order_by":2,"name":"Enrique Villarreal","email":"","orcid":"","institution":"Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Enrique","middleName":"","lastName":"Villarreal","suffix":""},{"id":250967226,"identity":"4c2d2804-8716-416a-9266-ec877c1007ca","order_by":3,"name":"Juan S. Farias","email":"","orcid":"","institution":"Children's Mercy Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Juan","middleName":"S.","lastName":"Farias","suffix":""},{"id":250967227,"identity":"69aae715-ba85-4184-a774-64588f97e265","order_by":4,"name":"Saul Flores","email":"","orcid":"","institution":"Texas Children's Hospital, Baylor College of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Saul","middleName":"","lastName":"Flores","suffix":""}],"badges":[],"createdAt":"2023-11-19 00:44:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3632444/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3632444/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00246-024-03427-7","type":"published","date":"2024-03-01T15:01:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":46879067,"identity":"25ad5b5f-59af-4f7e-bce5-427d2b793803","added_by":"auto","created_at":"2023-11-21 21:27:03","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":474747,"visible":true,"origin":"","legend":"\u003cp\u003eSummary of findings\u003c/p\u003e","description":"","filename":"figure1outlineoffindings.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3632444/v1/44c47348d07205d9669bb564.jpg"},{"id":46879068,"identity":"92b6411e-324b-4cf3-9ab5-41d9aa7e1e3e","added_by":"auto","created_at":"2023-11-21 21:27:04","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":319093,"visible":true,"origin":"","legend":"\u003cp\u003eLikelihood of postoperative atrioventricular block by specific congenital malformations of the heart\u003c/p\u003e","description":"","filename":"figure2percentavblockbydiagnosis.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3632444/v1/bc58f1e16f204673fefc432e.jpg"},{"id":46879066,"identity":"cb8018a4-1e54-4b4b-a0f0-b14f32822dbb","added_by":"auto","created_at":"2023-11-21 21:27:03","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":304054,"visible":true,"origin":"","legend":"\u003cp\u003eLikelihood of postoperative pacemaker placement by specific congenital malformations of the heart\u003c/p\u003e","description":"","filename":"figure3percentpacemakerforavblockbycardiacdiagnosis.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3632444/v1/c0e744eb0f04c47504ccdb08.jpg"},{"id":46879065,"identity":"910898ff-a2bc-4d60-8952-b069cc5e4ce5","added_by":"auto","created_at":"2023-11-21 21:27:03","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":21585,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operator curve analysis of the pacemaker placement risk score\u003c/p\u003e","description":"","filename":"figure4pacemakerriskroc.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3632444/v1/6b503b73c978f9b3f6587e72.jpg"},{"id":51958164,"identity":"a74c7ab3-cd8a-4411-93f8-acac9b759d6e","added_by":"auto","created_at":"2024-03-04 15:14:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1226408,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3632444/v1/c196bc19-3244-41f6-822b-58958f51b857.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Postoperative atrioventricular block in pediatric patients: impact of congenital cardiac malformations and medications","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAtrioventricular block occurs in approximately 5% of children after cardiac surgery. Of those who develop atrioventricular block, approximately 25% will undergo pacemaker placement [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While pacemaker placement helps restore sinus rhythm, it is associated with long-term morbidity such as need for pacemaker generator changes, lead replacements, infection, and pacemaker associated arrhythmia [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Thus, a decision to place a pacemaker in these children should not be taken lightly.\u003c/p\u003e \u003cp\u003eFew studies have examined the rates of postoperative atrioventricular block in children and have identified factors associated with atrioventricular block [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Previous studies have demonstrated that congenital malformations associated with a ventricular septal defect, such as double outlet right ventricle and atrioventricular septal defect, are associated with atrioventricular heart block [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, left ventricular outflow tract obstruction and discordant atrioventricular connections, such as in congenitally corrected transposition, have been shown to have increased rate of atrioventricular heart block [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Previous studies have also explored the amount of time from the onset of atrioventricular block to restoration of sinus rhythm or pacemaker placement with resolution of atrioventricular block usually occurring within 10 days.\u003c/p\u003e \u003cp\u003eMost of these previous studies were single center studies. The primary aim of this study was to utilize a multicenter database to determine factors associated with postoperative atrioventricular block.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eThe primary aim of this study was to determine factors associated with postoperative atrioventricular block. Secondary aims included determining factors associated with pacemaker placement in those with atrioventricular block.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eThis study is in concordance with the Helsinki declaration. Although all data are publicly available and deidentified, institutional review board approval was received November 22, 2021 at Texas Children's Hospital (protocol H-42889), as this was the institution where the data were retrieved.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePHIS database\u003c/h2\u003e \u003cp\u003eData for this study were obtained from the Pediatric Health Information System (PHIS) database. PHIS is an administrative and billing database that contains inpatient, emergency department, ambulatory surgery, and observation data from not-for-profit, tertiary care pediatric hospitals in the United States. Data for this study was available from 46 hospitals that contribute data to PHIS and are affiliated with the Children\u0026rsquo;s Hospital Association (CHA, Lenexa, KS), a business alliance of children\u0026rsquo;s hospitals. Data quality and reliability are assured through a joint effort between CHA and participating hospitals. For the purposes of external benchmarking, participating hospitals provide discharge/encounter data including demographics, diagnoses, procedures, and charges. Data are deidentified at the time of data submission, and data are subjected to reliability and validity checks before inclusion in the database.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData selection and extraction\u003c/h2\u003e \u003cp\u003eData from the PHIS database from 2016 to 2021 were utilized. This represents the most recent data that is available that utilizes ICD-10 codes. Intensive care unit admissions were identified utilizing the intensive care unit flag. Congenital heart disease was identified utilizing ICD-10 codes for various congenital malformations of the heart. Inclusion criteria for admissions utilized in the final analyses were: 1) pediatric admissions under 18 years of age; 2) cardiac surgery during the admission; 3) pre-operative length of stay of zero days such that a patient admission started with the operation so that it could be ensured that all interventions captured were postoperative.\u003c/p\u003e \u003cp\u003eThe presence of atrioventricular block was determined by querying the data for ICD-10 codes for first degree atrioventricular block, second degree atrioventricular block, and third-degree atrioventricular block to create a composite of these. Specific congenital malformations of the heart were identified using ICD-10 codes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The presence of specific comorbidities, including but not limited to acute kidney injury, chronic kidney disease, acute hepatic insufficiency, and respiratory distress syndrome were similarly identified. Some comorbidities had a secondary effect of serving as severity of illness measures such as individual organ dysfunction, acidosis, need for mechanical ventilation, need for extracorporeal membrane oxygen, and cardiac arrest. Heart failure was a composite variable consisting of systolic and/or diastolic dysfunction of the left and/or right ventricle. Genetic anomaly was a composite variable consisting of any identified syndrome or genetic aberration that was coded. Administered medications were also identified. These included a large variety of medications used in the cardiac intensive care unit including vasoactive medications, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, sedative medications, antiarrhythmic medications, electrolytes, and nutritional supplements. Of specific interest to these analyses, a variety of glucocorticoids were collected which included dexamethasone, methylprednisolone, prednisolone, and hydrocortisone. The timing of when specific morbidities occurred in the admission relative to one another was not available. The timing of specific medications was also not available. Pacemaker implantation was a composite of all ICD-10 codes pertaining to pacemaker implantation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eThe admissions found to meet inclusion criteria were divided into two groups: 1) those with atrioventricular block; and 2) those without atrioventricular block. Univariable comparisons were conducted with Mann-Whitney-U tests to compare continuous variables between groups and Fisher exact tests to compare descriptive variables between groups.\u003c/p\u003e \u003cp\u003eNext, a series of regressions were conducted. The first was a logistic regression to model postoperative atrioventricular block. This was a backward likelihood ratio logistic regression with admission age in months, all cardiac diagnosis data, all medication data, and all comorbidity data included as independent variables. All postoperative admissions found to meet the inclusion criteria were entered into this regression. The aim of this regression was to determine factors associated with postoperative atrioventricular block.\u003c/p\u003e \u003cp\u003eThe second regression was a linear regression to model length of stay in only admissions with postoperative atrioventricular block. This was a stepwise linear regression with admission age in months, all cardiac diagnosis data, all medication data, all comorbidity data, and need for pacemaker implantation included as independent variables. The aim of this regression was to determine factors associated with length of stay in those with postoperative atrioventricular block with the primary question being the impact of steroids.\u003c/p\u003e \u003cp\u003eThe third regression was a logistic regression to model pacemaker implantation in only admissions with postoperative atrioventricular block. This was a backward likelihood ratio logistic regression with admission age in months, all cardiac diagnosis data, all medication data, and all comorbidity data included as independent variables.\u003c/p\u003e \u003cp\u003eNext, a model was created to help characterize the probability of pacemaker implantation in those with postoperative atrioventricular block using the results from the logistic regression. This was done by including all significant variables found to be statistically significant and multiplying them by their beta coefficient. The products for all such significant independent variables and their beta coefficients were then summed. This resulted in what was then deemed the pacemaker risk score.\u003c/p\u003e \u003cp\u003eA receiver operator curve analysis was then conducted to determine the accuracy of the pacemaker risk score in identifying patients who did undergo pacemaker implantation. Distance from a diagonal reference line as well as K-S statistics were utilized to determine an optimal cutoff. Sensitivity, specificity, positive predictive valve, and negative predictive value of the pacemaker risk score were then calculated using the cutoff value determined by the K-S statistics.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eCohort information\u003c/h2\u003e \u003cp\u003eA total of 43,716 admissions were included in the analyses. Of these 43,716 admissions, 2,093 (5%) developed postoperative atrioventricular block. Of these, 2,093 admissions who developed atrioventricular block, 480 (23%) underwent pacemaker implantation (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eOf the 2,093 postoperative admissions with atrioventricular block who ultimately underwent pacemaker implantation, 347 (72%) had received steroids. Of the 1,613 postoperative admissions with atrioventricular block who ultimately underwent pacemaker implantation, 1,121 (69%) had received steroids. The proportion of steroids in those with postoperative atrioventricular block who did or did not undergo pacemaker implantation was not statistically significantly different (Fig.\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCongenital cardiac malformations and postoperative atrioventricular block\u003c/h2\u003e \u003cp\u003eThe following cardiac malformations were associated with an increased likelihood of postoperative atrioventricular block by univariable analyses: double outlet right ventricle, transposition, double inlet left ventricle, discordant atrioventricular connections, isomerism, ventricular septal defect, atrioventricular septal defect, Ebstein anomaly, mitral stenosis, and subaortic stenosis. The following cardiac malformations were associated with a decreased likelihood of postoperative atrioventricular block: atrial septal defect, tricuspid stenosis, coarctation of the aorta, and double aortic arch (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCardiac diagnoses of those with and without postoperative atrioventricular block\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo atrioventricular block (n\u0026thinsp;=\u0026thinsp;41,623)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAtrioventricular block (n\u0026thinsp;=\u0026thinsp;2,093)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommon arterial trunk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e427 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble outlet right ventricle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,690 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e233 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble outlet left ventricle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransposition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,873 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble inlet left ventricle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,004 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscordant atrioventricular connections\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e424 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIsomerism\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVentricular septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,330 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e743 (35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtrial septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20,279 (48.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e853 (40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtrioventricular septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,804 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e399 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTetralogy of Fallot\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,809 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAortopulmonary septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)_\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary atresia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e984 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary valve stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,372 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTricuspid stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,133 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEbstein anomaly\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e586 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypoplastic right heart syndrome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e564 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAortic stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e773 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMitral stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e915 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypoplastic left heart syndrome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,210 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDivided atrium\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubaortic stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,385 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoronary artery malformation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,317 (41,623)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoarctation of the aorta\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,479 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInterruption of the aorta\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e260 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble aortic arch\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e597 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRight aortic arch\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e868 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn cardiac malformations associated with an increased likelihood of postoperative atrioventricular block, the risk of postoperative atrioventricular block was as follows: 20% with discordant atrioventricular connections, 11% with Ebstein anomaly, 10% with subaortic stenosis, 10% with transposition, 9% with ventricular septal defect, 9% with mitral stenosis, 8% with isomerism, 8% with double outlet right ventricle, and 7% with double inlet left ventricle (Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eIn cardiac malformations associated with an increased likelihood of pacemaker implantation for atrioventricular block, the risk of postoperative atrioventricular block was as follows: 39% with hypoplastic right heart syndrome, 39% with discordant atrioventricular connections, 39% with double inlet left ventricle, 35% with subaortic stenosis, and 33% with transposition (Fig.\u0026nbsp;3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRegression analysis of factors associated with postoperative atrioventricular block\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e outlines the variables statistically significantly associated with postoperative atrioventricular block. Older age, double outlet right ventricle, transposition, discordant atrioventricular connections, ventricular septal defect, atrioventricular septal defect, Ebstein anomaly, mitral stenosis subaortic stenosis, acute kidney injury, trisomy 21, extracorporeal membrane oxygenation, epinephrine, milrinone, carvedilol, propranolol, isoproterenol, enalapril, digoxin, amiodarone, procainamide, hydrocortisone, and methylprednisolone were all found to be associated with increased likelihood of postoperative atrioventricular block. Factors such as atrial septal defect, pulmonary atresia, tricuspid stenosis, coronary artery malformation, coarctation of the aorta, double aortic arch, total anomalous pulmonary venous connection, and atenolol were found to be associated with decreased likelihood of postoperative atrioventricular block.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with postoperative atrioventricular block. Only statistically significant variables are included in the table.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOdds ratio (95% confidence interval)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.003 (1.003 to 1.004)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble outlet right ventricle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.310 (1.118 to 1.536)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransposition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.616 (1.357 to 1.923)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscordant atrioventricular connections\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.796 (2.983 to 4.832)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVentricular septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.796 (2.983 to 4.832)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtrial septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.901 (0.814 to 0.999)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtrioventricular septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.618 (1.399 to 1.870)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary atresia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.633 (0.446 to 0.899)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTricuspid stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.612 (0.439 to 0.852)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEbstein anomaly\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.012 (1.531 to 2.643)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMitral stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.575 (1.244 to 1.993)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubaortic stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.972 (1.631 to 2.385)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoronary artery malformation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.644 (0.478 to 0.867)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoarctation of the aorta\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.728 (0.580 to 0.913)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble aortic arch\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.294 (0.109 to 0.797)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal anomalous pulmonary venous connection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.610 (0.417 to 0.893)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcute kidney injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.208 (1.024 to 1.425)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrisomy 21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.753 (1.499 to 2.050)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExtracorporeal membrane oxygenation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.400 (1.128 to 1.737)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEpinephrine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.410 (1.251 to 1.589)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMilrinone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.155 (1.021 to 1.306)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCarvedilol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.762 (1.338 to 2.320)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePropranolol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.255 (1.015 to 1.553)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtenolol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.700 (0.491 to 0.998)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIsoproterenol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.761 (5.136 to 8.899)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnalapril\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.296 (1.149 to 1.463)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDigoxin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.292 (1.084 to 1.540)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAmiodarone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.766 (1.493 to 2.090)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProcainamide\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.874 (1.421 to 2.471)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHydrocortisone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.316 (1.143 to 1.515)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMethylprednisolone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.116 (1.005 to 1.238)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIt is important to keep in mind that these findings are not causal and are simply associations. This holds true for all the regression results. Thus, a finding such as epinephrine being associated with an increased likelihood of postoperative atrioventricular block may not represent a mechanism by which epinephrine caused atrioventricular block but rather may represent the fact that epinephrine was utilized after development of atrioventricular block for direct or indirect reasons.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRegression analysis of factors associated with length of stay in those with postoperative atrioventricular block\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e outlines the variables statistically significantly associated with total length of stay in admissions with postoperative atrioventricular block. The beta-coefficient represents the number of days (either increase or decrease) in length of stay that the variable was associated with. The following factors were associated with increased length of stay: transposition, pulmonary valve stenosis, coarctation of the aorta, total anomalous pulmonary venous connection, acute kidney injury, infection, cardiac arrest, extracorporeal membrane oxygenation, epinephrine, norepinephrine, dopamine, dobutamine, isoproterenol, digoxin, and angiotensin converting enzyme inhibitor.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression results charactering factors associated with length of stay in those with postoperative atrioventricular block. Only statistically significant variables are included.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransposition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary valve stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoarctation of the aorta\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal anomalous pulmonary venous connection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGenetic anomaly\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcute kidney injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCardiac arrest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExtracorporeal membrane oxygenation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEpinephrine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNorepinephrine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDopamine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDobutamine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIsoproterenol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDigoxin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAngiotensin converting enzyme inhibitor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSteroid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf particular note, steroids did not decrease length of stay in those with postoperative atrioventricular block.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRegression analysis of factors associated with pacemaker implantation in those with postoperative atrioventricular block\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e outlines the statistically significant variables associated with pacemaker implantation in admissions with postoperative atrioventricular block. Older age, double inlet left ventricle, discordant atrioventricular connections, isomerism, ventricular septal defect, subaortic stenosis, dopamine, isoproterenol, enalapril, lisinopril, dexamethasone, and liothyronine were associated with increased likelihood of pacemaker implantation in those with postoperative atrioventricular block. Atrial septal defect, sodium nitroprusside, digoxin, amiodarone, procainamide, and sildenafil were associated with a lower likelihood of pacemaker implantation in those with postoperative atrioventricular block.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with pacemaker implantation in those with postoperative atrioventricular block. Only statistically significant variables are included in this table.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOdds ratio (95% confidence interval)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.002 (1.001 to 1.004)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDouble inlet left ventricle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.662 (1.096 to 2.520)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscordant atrioventricular connections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.753 (1.091 to 2.818)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsomerism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.021 (1.005 to 9.549)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentricular septal defect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.361 (1.045 to 1.772)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial septal defect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.581 (0.447 to 0.754)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubaortic stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.535\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.707 (1.125 to 2.583)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDopamine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.299 (1.015 to 1.663)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsoproterenol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.267 (0.814 to 1.973)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnalapril\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.751 (1.326 to 2.313)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLisinopril\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.066 (1.307 to 3.263)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChlorothiazide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.481 (1.126 to 1.948)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium nitroprusside\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.684 (0.506 to 0.923)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigoxin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.509 (0.310 to 0.835)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmiodarone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.624 (0.395 to 0.985)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcainamide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.300 (0.125 to 0.720)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSildenafil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.555 (0.353 to 0.871)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDexamethasone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.482 (1.168 to 1.880)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiothyronine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.608 (1.843 to 50.081)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eModel performance for identifying admissions with postoperative atrioventricular block that get pacemaker implantation\u003c/h2\u003e \u003cp\u003eA model was created using the findings from the regression for pacemaker implantation in those with postoperative atrioventricular block. The median score was 0.35 in those who didn't have a pacemaker implanted and 0.91 in those who did. The resulting score had an area under the curve of 0.715 to identify those who underwent pacemaker implantation (Fig.\u0026nbsp;4). The optimal cutoff was 0.59. This had a sensitivity of 68%, specificity of 65%, positive predictive value of 36%, and negative predictive value of 87%. Thus, this score was able to identify with good ability, admissions with postoperative atrioventricular block that would not undergo pacemaker implantation but not those that would undergo pacemaker implantation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eOverview of regression results\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e collates all statistically significant associations. Isoproterenol was associated with an increased likelihood of atrioventricular block, increased length of stay, and increased likelihood of pacemaker implantation. This is more likely the result of atrioventricular block wherein isoproterenol was started to try to restore sinus rhythm after the development of postoperative atrioventricular block. Enalapril was also associated with an increase in the likelihood of atrioventricular block, increase in length of stay in those who have postoperative atrioventricular block, and increase in the likelihood of pacemaker implantation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of significant findings from each regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostoperative atrioventricular block\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLength of stay in those with atrioventricular block\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePacemaker implantation in those with atrioventricular block\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (in months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble outlet right ventricle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble inlet left ventricle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransposition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscordant atrioventricular connections\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVentricular septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtrial septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtrioventricular septal defect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary atresia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTricuspid stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEbstein anomaly\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMitral stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary valve stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubaortic stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoronary artery malformation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoarctation of the aorta\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDouble aortic arch\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal anomalous pulmonary venous connection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcute kidney injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrisomy 21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCardiac arrest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExtracorporeal membrane oxygenation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEpinephrine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNorepinephrine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDopamine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDobutamine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMilrinone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCarvedilol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePropranolol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAtenolol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIsoproterenol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnalapril\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDigoxin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAmiodarone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProcainamide\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHydrocortisone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMethylprednisolone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDexamethasone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOlder age, discordant atrioventricular connections, ventricular septal defect, and subaortic stenosis were associated with both an increased likelihood of postoperative atrioventricular block and increased likelihood of pacemaker implantation for the postoperative atrioventricular block. The discordant atrioventricular connections, ventricular septal defect, and subaortic stenosis being associated with increased atrioventricular block is likely due to the anatomic location of the conduction axis and its proximity to areas of repair in these hearts, particularly ventricular septal defect and subaortic stenosis.\u003c/p\u003e \u003cp\u003eDigoxin, amiodarone, and procainamide were associated with increased likelihood of postoperative atrioventricular block and decreased likelihood of pacemaker implantation. This likely represents initiation of these medications and subsequent discontinuation in the setting of prolonged atrioventricular block, thus changing the direction of the association by the time of potential pacemaker implantation.\u003c/p\u003e \u003cp\u003eOther malformations, comorbidities, and medications were associated with only a single one of the outcomes of interest.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSubset analysis\u003c/h2\u003e \u003cp\u003eWhen the analyses were repeated including only those with third-degree atrioventricular block, factors associated with third-degree atrioventricular block did not significantly differ from all atrioventricular block. The rates of pacemaker placement were slightly higher in this subset. Regression results did not differ significantly either.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study utilizes data from the pediatric health information systems database to characterize postoperative atrioventricular block in pediatric patients undergoing cardiac surgery. Five percent of patients developed postoperative atrioventricular block and of those who developed postoperative atrioventricular block, 23% underwent pacemaker implantation. No medical intervention, such as isoproterenol or steroids, was associated with a decreased likelihood of pacemaker implantation in those who developed postoperative atrioventricular block. Steroids were administered to 70% of those with postoperative atrioventricular block.\u003c/p\u003e \u003cp\u003eThe proportion of postoperative patients who developed atrioventricular block in the current study is similar to what has been described in previous studies. Previous studies have reported rates of postoperative atrioventricular blocks from 1.4\u0026ndash;11% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The variability in the numbers exists due to specific subsets of patients that were included in some studies as well as what was defined as atrioventricular block. The current study included first, second-, and third-degree atrioventricular block as atrioventricular block while other studies only include second- and third-degree atrioventricular block or only third-degree atrioventricular block. Previous studies have reported rates of pacemaker placement in those with postoperative atrioventricular block between 31\u0026ndash;49% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The current study reports a rate of 23%, a figure likely lower than previous reports due to the inclusion of first-, second-, and third-degree atrioventricular block.\u003c/p\u003e \u003cp\u003eCardiac malformations associated with postoperative atrioventricular block in the current study were double outlet right ventricle, transposition, ventricular septal defect, atrioventricular septal defect, discordant atrioventricular connections, Ebstein anomaly, mitral stenosis, and subaortic stenosis. Double outlet right ventricle, ventricular septal defect, and atrioventricular septal defect are not surprising as a ventricular septal defect is found in all of the aforementioned malformations and often reside in close proximity to the conduction system, particularly the atrioventricular node and the proximal bundles. Such findings are consistent with previous reports [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Discordant atrioventricular connections, seen in congenitally corrected transposition, were also intuitively associated with postoperative atrioventricular block due to the known malformations in the conduction tissue [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Ebstein's anomaly was also found to be associated with atrioventricular block. Ebstein's has been described to have higher rates of atrioventricular block although this is generally first- or second-degree atrioventricular block and is hypothesized to be secondary to atrial dilation. Finally, subaortic stenosis was noted in the current study to be associated with atrioventricular block, consistent with previous studies. This association is also not particularly surprising, as the left bundle branch emerges on the left side in the left ventricular outflow tract and an intervention, specifically any removal of myocardium in this region, may lead to damage to the conduction tissues [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome medications were found to be associated with increased likelihood of postoperative block such as epinephrine, milrinone, isoproterenol, digoxin, amiodarone, procainamide, hydrocortisone, and methylprednisolone. Agents such as epinephrine, milrinone, isoproterenol, hydrocortisone, and methylprednisolone were probably associated with atrioventricular block as they were started as a result of the atrioventricular block. For instance, steroids and isoproterenol may have been started to help try to restore sinus rhythm. Epinephrine may have been used similarly or to overcome impaired systemic oxygen delivery due to atrioventricular block. Agents such as digoxin, amiodarone, and procainamide have a less intuitive connection to atrioventricular block. It is possible that these agents were started after resolution of the atrioventricular block as the result of other arrhythmias or were started for some reason prior to the atrioventricular block and promoted it. With the data available in the database, it is not possible to fully delineate this association.\u003c/p\u003e \u003cp\u003eInterestingly, the same congenital malformations of the heart that were associated with an increased likelihood of postoperative atrioventricular block were not necessarily the same congenital malformations that were associated with increased likelihood of pacemaker implantation once postoperative atrioventricular block developed. These malformations were double inlet left ventricle, discordant atrioventricular connections, ventricular septal defect, and subaortic stenosis. Many of these are associated with abnormal conduction tissues.\u003c/p\u003e \u003cp\u003eMedications such as isoproterenol and dexamethasone were associated with an increased likelihood of pacemaker implantation and likely represent medications used to restore sinus rhythm. Some medications such as digoxin, amiodarone, and procainamide were associated with decreased likelihood of atrioventricular block but the association likely represents avoidance of these agents once postoperative atrioventricular block was present.\u003c/p\u003e \u003cp\u003eThis study could not necessarily determine duration of time to sinus rhythm recovery or pacemaker placement following atrioventricular block. Previous studies have demonstrated that those with atrioventricular block who had recovery of sinus rhythm mostly did so in the first week and rarely after 7 to 12 days [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese data represent the largest cohort from which data is derived to explore postoperative atrioventricular block in children undergoing cardiac surgery. Congenital malformations of the heart, comorbidities, and medications were all available in the database and their associations with atrioventricular block and pacemaker placement could be assessed. Despite the strengths of the study there are limitations. There is no data regarding the timing of any of the medications, atrioventricular block, or pacemaker placement. To try to overcome this, only admissions with no postoperative length of stay were included such that only admissions that started with the index operation were included. Thus, all the medications were administered after the operation, atrioventricular block developed after surgery and pacemakers placed were placed after the index operation. No details on medication dosage or duration were available in the database.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePostoperative atrioventricular block occurred in 5% of pediatric admissions for cardiac surgery. Of these admissions with postoperative atrioventricular block, 23% required pacemaker placement. Isoproterenol and steroids were not associated with a reduction in the likelihood of pacemaker placement.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRL- study design, data preparation, data analysis, manuscript preparation, manuscript reviewJP- study design, manuscript preparation, manuscript reviewEV- study design, manuscript preparation, manuscript reviewJF- study design, manuscript preparation, manuscript reviewSF- study design, data procurement, manuscript preparation, manuscript review\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRobinson JA, Leclair G, Escudero CA (2023) Pacing in Pediatric Patients with Postoperative Atrioventricular Block. Card Electrophysiol Clin 15:401\u0026ndash;411\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomer AJ, Tabbutt S, Etheridge SP, Fischbach P, Ghanayem NS, Reddy VM, Sahulee R, Tanel RE, Tweddell JS, Gaies M, Banerjee M, Retzloff L, Zhang W, Patel AR (2019) Atrioventricular block after congenital heart surgery: Analysis from the Pediatric Cardiac Critical Care Consortium. J Thorac Cardiovasc Surg 157:1168\u0026ndash;1177 e1162\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilhelm BJ, Thone M, El-Scheich T, Livert D, Angelico R, Osswald B (2015) Complications and Risk Assessment of 25 Years in Pediatric Pacing. Ann Thorac Surg 100:147\u0026ndash;153\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoak JP, Hasbani K, Ramwell C, Freedenberg V, Berger JT, DiRusso G, Callahan P (2006) Dilated cardiomyopathy following right ventricular pacing for AV block in young patients: resolution after upgrading to biventricular pacing systems. J Cardiovasc Electrophysiol 17:1068\u0026ndash;1071\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JJ, Friedman RA, Eidem BW, Cannon BC, Arora G, Smith EO, Fenrich AL, Kertesz NJ (2007) Ventricular function and long-term pacing in children with congenital complete atrioventricular block. J Cardiovasc Electrophysiol 18:373\u0026ndash;377\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebauer RA, Tomek V, Salameh A, Marek J, Chaloupecky V, Gebauer R, Matejka T, Vojtovic P, Janousek J (2009) Predictors of left ventricular remodelling and failure in right ventricular pacing in the young. Eur Heart J 30:1097\u0026ndash;1104\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyyildiz P, Kasar T, Ozturk E, Ozyilmaz I, Tanidir IC, Guzeltas A, Ergul Y (2016) Evaluation of Permanent or Transient Complete Heart Block after Open Heart Surgery for Congenital Heart Disease. Pacing Clin Electrophysiol 39:160\u0026ndash;165\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaredo M, Khraiche D, Raisky O, Gaudin R, Bajolle F, Maltret A, Chevret S, Bonnet D, Vouhe PR (2018) Long-term results of the modified Konno procedure in high-risk children with obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 156:2285\u0026ndash;2294 e2282\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuong SQ, Shi Y, Giacone H, Navarre BM, Gal DB, Han B, Sganga D, Ma M, Reddy CD, Shin AY, Kwiatkowski DM, Dubin AM, Scheinker D, Algaze CA (2022) Criteria for Early Pacemaker Implantation in Patients With Postoperative Heart Block After Congenital Heart Surgery. Circ Arrhythm Electrophysiol 15:e011145\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiehr SL, Hanley FL, Reddy VM, Miyake CY, Dubin AM (2014) Incidence and risk factors of complete atrioventricular block after operative ventricular septal defect repair. Congenit Heart Dis 9:211\u0026ndash;215\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzturk E, Kafali HC, Tanidir IC, Tunca Sahin G, Onan IS, Haydin S, Guzeltas A, Ergul Y (2021) Early postoperative arrhythmias in patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg 29:27\u0026ndash;35\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurray LE, Smith AH, Flack EC, Crum K, Owen J, Kannankeril PJ (2017) Genotypic and phenotypic predictors of complete heart block and recovery of conduction after surgical repair of congenital heart disease. Heart Rhythm 14:402\u0026ndash;409\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAziz PF, Serwer GA, Bradley DJ, LaPage MJ, Hirsch JC, Bove EL, Ohye RG, Dick M 2nd (2013) Pattern of recovery for transient complete heart block after open heart surgery for congenital heart disease: duration alone predicts risk of late complete heart block. Pediatr Cardiol 34:999\u0026ndash;1005\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeindling SN, Saul JP, Gamble WJ, Mayer JE, Wessel D, Walsh EP (1998) Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol 82:525\u0026ndash;527\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Mambro C, Calvieri C, Silvetti MS, Tamburri I, Giannico S, Baban A, Albanese S, Brancaccio G, Carotti A, Iorio FS, Drago F (2018) Bradyarrhythmias in Repaired Atrioventricular Septal Defects: Single-Center Experience Based on 34 Years of Follow-Up of 522 Patients. Pediatr Cardiol 39:1590\u0026ndash;1597\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacobs JP, Franklin RCG, Beland MJ, Spicer DE, Colan SD, Walters HL, Bailliard F, Houyel L, St Louis JD, Lopez L, Aiello VD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski BJ, Stellin G, Weinberg PM, Jacobs ML, Boris JR, Cohen MS, Everett AD, Giroud JM, Guleserian KJ, Hughes ML, Juraszek AL, Seslar SP, Shepard CW, Srivastava S, Cook AC, Crucean A, Hernandez LE, Loomba RS, Rogers LS, Sanders SP, Savla JJ, Tierney ESS, Tretter JT, Wang L, Elliott MJ, Mavroudis C, Tchervenkov CI (2021) Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). Cardiol Young 31:1057\u0026ndash;1188\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacobs JP, Franklin RCG, Beland MJ, Spicer DE, Colan SD, Walters HL 3rd, Bailliard F, Houyel L, St Louis JD, Lopez L, Aiello VD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski BJ, Stellin G, Weinberg PM, Jacobs ML, Boris JR, Cohen MS, Everett AD, Giroud JM, Guleserian KJ, Hughes ML, Juraszek AL, Seslar SP, Shepard CW, Srivastava S, Cook AC, Crucean A, Hernandez LE, Loomba RS, Rogers LS, Sanders SP, Savla JJ, Tierney ESS, Tretter JT, Wang L, Elliott MJ, Mavroudis C, Tchervenkov CI (2021) Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). World J Pediatr Congenit Heart Surg 12:E1\u0026ndash;E18\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-cardiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pedc","sideBox":"Learn more about [Pediatric Cardiology](http://link.springer.com/journal/246)","snPcode":"246","submissionUrl":"https://submission.nature.com/new-submission/246/3","title":"Pediatric Cardiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3632444/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3632444/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostoperative atrioventricular block may occur after pediatric cardiac surgery. A small proportion of those who develop atrioventricular block will require pacemaker placement. The primary aim of this study was to determine factors associated with postoperative atrioventricular block. Secondary aims included determining factors associated with pacemaker placement in those with atrioventricular block.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eData from the PHIS data was utilized to identify patients under 18 years of age who underwent cardiac surgery. Those who did and did not develop atrioventricular block. Univariable analyses and regression analyses were conducted to determine factors associated with postoperative atrioventricular block. Similar analyses were conducted to determine factors associated with pacemaker placement in those with atrioventricular block.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 43,716 admissions were identified. Of these, 2,093 (5%) developed atrioventricular block and 480 (1% of total admissions) underwent pacemaker placement. Approximately 70% of those with atrioventricular block received steroids but this was not associated with a decrease in pacemaker placement. Risk factors (congenital malformations of the heart, comorbidities, medications) associated with increased risk of atrioventricular block and pacemaker placement were identified.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePostoperative atrioventricular block occurred in 5% of pediatric admissions for cardiac surgery. Of these admissions with postoperative atrioventricular block, 23% required pacemaker placement. Isoproterenol and steroids were not associated with a reduction in the likelihood of pacemaker placement.\u003c/p\u003e","manuscriptTitle":"Postoperative atrioventricular block in pediatric patients: impact of congenital cardiac malformations and medications","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-21 21:26:58","doi":"10.21203/rs.3.rs-3632444/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-04T15:28:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-11-20T19:11:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75995aea-3aba-4843-9a29-d2c6165d7081","date":"2023-11-19T23:57:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-11-19T23:51:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-11-19T10:32:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-11-19T10:32:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Cardiology","date":"2023-11-19T00:30:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-cardiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pedc","sideBox":"Learn more about [Pediatric Cardiology](http://link.springer.com/journal/246)","snPcode":"246","submissionUrl":"https://submission.nature.com/new-submission/246/3","title":"Pediatric Cardiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"bd214cfc-03b4-4287-8bc1-e8b352d20db4","owner":[],"postedDate":"November 21st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-03-04T15:04:49+00:00","versionOfRecord":{"articleIdentity":"rs-3632444","link":"https://doi.org/10.1007/s00246-024-03427-7","journal":{"identity":"pediatric-cardiology","isVorOnly":false,"title":"Pediatric Cardiology"},"publishedOn":"2024-03-01 15:01:00","publishedOnDateReadable":"March 1st, 2024"},"versionCreatedAt":"2023-11-21 21:26:58","video":"","vorDoi":"10.1007/s00246-024-03427-7","vorDoiUrl":"https://doi.org/10.1007/s00246-024-03427-7","workflowStages":[]},"version":"v1","identity":"rs-3632444","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3632444","identity":"rs-3632444","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}