Association Between Milrinone Use and Cardiac Arrhythmias in Pediatric Cardiac Surgeries

Arrhythmia Risk with Milrinone

In patients undergoing elective cardiac surgery, perioperative milrinone was associated with a 2-4 fold increased risk of postoperative atrial fibrillation (58.2% vs. 26.1% in non-users) 1
Patients who develop postoperative atrial fibrillation after receiving milrinone have longer hospital stays (p < 0.001) and a higher likelihood of death (p = 0.02) 1

In patients with low cardiac output after cardiac surgery, dobutamine was associated with a higher incidence of atrial fibrillation than milrinone (18% vs 5%; p < 0.04) 1
When comparing inotropes in adults, patients treated with norepinephrine had fewer arrhythmias than those treated with dopamine (12% versus 24%) 2, 3

Milrinone is effective in preventing low cardiac output syndrome (LCOS) in infants and children following biventricular cardiac repair 2, 3
Children had better hemodynamic parameters and shorter ICU stays when receiving milrinone compared to low-dose epinephrine plus nitroglycerin for inotropic support following repair of tetralogy of Fallot 2, 3
Milrinone improved cardiac index in neonates with low cardiac output following cardiac surgery 2, 3

The American Heart Association recommends that the catecholamine dose for inotropic support in cardiogenic shock must be individually titrated due to wide variability in clinical response 2, 3
Milrinone may be beneficial for the prevention and treatment of low cardiac output following cardiac surgery, despite the arrhythmia risk 2, 3
In patients with single-ventricle physiology, milrinone can be used to reduce systemic vascular resistance and improve systemic blood flow and oxygen delivery 4