Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 11, Number 5, October 2020, pages 274-279

Heart Rate Changes Following the Administration of Sugammadex to Infants and Children With Comorbid Cardiac, Cardiovascular, and Congenital Heart Diseases

Figure 1. Average heart rate for the first 30 min following sugammadex administration (n = 92). Seven patients with bradycardia at baseline were eliminated.

Figure 2. Average heart rate for the first 30 min following sugammadex in patients with comorbid cardiac, cardiovascular, and congenital heart diseases (n = 92). Seven patients with bradycardia at baseline were eliminated. CHD: congenital heart disease.

**Table 1.** Bradycardia in Patients After Sugammadex Administration
Patient	Definition of bradycardia for the patient (beats/min)	Baseline heart rate (beats/min)	Bradycardic at baseline	Lowest heart rate after sugammadex (beats/min)	Bradycardic after sugammadex	Absolute difference in heart rate from baseline (beats/min)
1	≤ 61	56	Yes	57	Yes	1
2	≤ 92	91	Yes	87	Yes	4
3	≤ 82	73	Yes	73	Yes	0
4	≤ 87	87	Yes	87	Yes	0
5	≤ 113	110	Yes	106	Yes	4
6	≤ 108	91	Yes	90	Yes	1
7	≤ 66	71	No	62	Yes	9
8	≤ 66	69	No	56	Yes	13
9	≤ 61	79	No	46	Yes	33
10	≤ 82	84	No	79	Yes	5
11	≤ 113	118	No	106	Yes	12
12	≤ 108	109	No	107	Yes	2
13	≤ 77	82	No	71	Yes	11
14	≤ 57	73	No	53	Yes	20
15	≤ 108	135	No	76	Yes	59
16	≤ 61	70	No	44	Yes	26
17	≤ 61	99	No	51	Yes	48
18	≤ 108	110	No	108	Yes	2
19	≤ 66	68	No	64	Yes	4
20	≤ 82	83	No	79	Yes	4

Table 1. Bradycardia in Patients After Sugammadex Administration

Patient

Definition of bradycardia for the patient (beats/min)

Baseline heart rate (beats/min)

Bradycardic at baseline

Lowest heart rate after sugammadex (beats/min)

Bradycardic after sugammadex

Absolute difference in heart rate from baseline (beats/min)

≤ 61

Yes

≤ 92

Yes

≤ 82

Yes

≤ 87

Yes

≤ 113

110

Yes

106

Yes

≤ 108

Yes

≤ 66

Yes

≤ 66

Yes

≤ 61

Yes

≤ 82

Yes

≤ 113

118

106

Yes

≤ 108

109

107

Yes

≤ 77

Yes

≤ 57

Yes

≤ 108

135

Yes

≤ 61

Yes

≤ 61

Yes

≤ 108

110

108

Yes

≤ 66

Yes

≤ 82

Yes

**Table 2.** Patient and Procedural Characteristics According to Occurrence of Bradycardia^a
Variable	All (n = 99)	Bradycardia/no (n = 78)	Bradycardia/yes (n = 14)	P value^b
Date presented as n (%) or median (IQR). ^aSeven patients with bradycardia at baseline were eliminated from the bradycardia/yes versus bradycardia/ no comparison. ^bDifference between groups tested using Fisher’s exact test. ^cDifference between groups tested using Mann-Whitney U test. IQR: interquartile range; n: number.
Gender, female	41 (41)	32 (41)	4 (28.6)	0.554
Age (years)	3 (0, 10)	2.5 (0, 9)	7.5 (0, 12)	0.292^c
Weight (kg)	13.5 (6.5, 30.7)	13.4 (6.6, 30.7)	21.3 (6.3, 40.4)	0.344^c
Procedures
Cardiac surgery	45 (45.5)	38 (48.7)	4 (28.6)	0.245
Non-cardiac surgery	5 (5.0)	4 (5.1)	1 (7.1)	0.570
Cardiac catheterization	29 (29.3)	23 (29.5)	5 (35.7)	0.754
Electrophysiology study	20 (20.2)	13 (16.7)	4 (28.6)	0.283
Initial sugammadex dose (mg/kg)	3.9 (2.1, 4.0)	3.9 (2.1, 4.0)	2.7 (2.1, 3.9)	0.243^c
Baseline heart rate (beats/min)	107 (84, 130)	113 (91, 133)	83 (71, 109)	0.003^c
Heart rate decrease (beats/min)	4 (1, 11)	4 (1, 8)	12 (4, 26)	0.006^c

Table 2. Patient and Procedural Characteristics According to Occurrence of Bradycardia^a

Variable

All (n = 99)

Bradycardia/no (n = 78)

Bradycardia/yes (n = 14)

P value^b

Date presented as n (%) or median (IQR). ^aSeven patients with bradycardia at baseline were eliminated from the bradycardia/yes versus bradycardia/ no comparison. ^bDifference between groups tested using Fisher’s exact test. ^cDifference between groups tested using Mann-Whitney U test. IQR: interquartile range; n: number.

Gender, female

41 (41)

32 (41)

4 (28.6)

0.554

Age (years)

3 (0, 10)

2.5 (0, 9)

7.5 (0, 12)

0.292^c

Weight (kg)

13.5 (6.5, 30.7)

13.4 (6.6, 30.7)

21.3 (6.3, 40.4)

0.344^c

Procedures

Cardiac surgery

45 (45.5)

38 (48.7)

4 (28.6)

0.245

Non-cardiac surgery

5 (5.0)

4 (5.1)

1 (7.1)

0.570

Cardiac catheterization

29 (29.3)

23 (29.5)

5 (35.7)

0.754

Electrophysiology study

20 (20.2)

13 (16.7)

4 (28.6)

0.283

Initial sugammadex dose (mg/kg)

3.9 (2.1, 4.0)

2.7 (2.1, 3.9)

0.243^c

Baseline heart rate (beats/min)

107 (84, 130)

113 (91, 133)

83 (71, 109)

0.003^c

Heart rate decrease (beats/min)

4 (1, 11)

4 (1, 8)

12 (4, 26)

0.006^c

**Table 3.** Multivariable Regression of Characteristics Associated With Bradycardia (N = 92)^a
Characteristics	Odds ratio	95% confidence interval	P value
^aSeven patients with bradycardia at baseline were eliminated from multivariable regression analysis.
Female	0.58	0.17, 1.99	0.383
Age (years)	1.06	0.96, 1.17	0.247
Weight (kg)	1.01	0.99, 1.04	0.413
Initial sugammadex dose (mg/kg)	0.67	0.40, 1.13	0.132

Table 3. Multivariable Regression of Characteristics Associated With Bradycardia (N = 92)^a

Characteristics

Odds ratio

95% confidence interval

P value

^aSeven patients with bradycardia at baseline were eliminated from multivariable regression analysis.

Female

0.58

0.17, 1.99

0.383

Age (years)

1.06

0.96, 1.17

0.247

Weight (kg)

1.01

0.99, 1.04

0.413

Initial sugammadex dose (mg/kg)

0.67

0.40, 1.13

0.132

**Table 4.** Cardiac Comorbid Conditions in the Study Cohort (N = 99)
Cardiac comorbid condition^a	All (n = 99)	Bradycardia/no (n = 78)	Bradycardia/yes (n = 14)
^aSeven patients with bradycardia at baseline were eliminated from the bradycardia/yes versus bradycardia/no comparison. ^bAtrial septal defect, ventricular septal defect, patent ductus arteriosus, atrioventricular canal, tetralogy of Fallot, hypoplastic left heart syndrome, pulmonary atresia, coarctation of the aorta and truncus arteriosus.
Congenital heart disease^b	72	59	8
Valvular heart disease (pulmonary or aortic stenosis)	4	3	1
Cardiomyopathy	3	3	0
Status post heart transplant	3	2	1
Arrhythmias	15	9	4
No other cardiac comorbidity	2	2	0

Table 4. Cardiac Comorbid Conditions in the Study Cohort (N = 99)

Cardiac comorbid condition^a

All (n = 99)

Bradycardia/no (n = 78)

Bradycardia/yes (n = 14)

^aSeven patients with bradycardia at baseline were eliminated from the bradycardia/yes versus bradycardia/no comparison. ^bAtrial septal defect, ventricular septal defect, patent ductus arteriosus, atrioventricular canal, tetralogy of Fallot, hypoplastic left heart syndrome, pulmonary atresia, coarctation of the aorta and truncus arteriosus.

Congenital heart disease^b

Valvular heart disease (pulmonary or aortic stenosis)

Cardiomyopathy

Status post heart transplant

Arrhythmias

No other cardiac comorbidity