Diagnosis and management of junctional ectopic tachycardia in children

Abstract

Junctional ectopic tachycardia (JET) is more common in its postoperative form. A thorough understanding of its etiology, pathophysiology, and management strategies is essential. Classically, postoperative JET is considered to arise from surgical trauma. Genetic susceptibility and an intrinsic morphologic/functional defect in the conduction system inherent in congenital heart diseases likely play a significant role. The devastating effects on postoperative hemodynamics warrant prompt attention. A multipronged management approach with general measures, pharmacotherapy, and pacing has decreased morbidity and mortality. Amiodarone and procainamide remain the preferred drugs, while ivabradine appears promising. Carefully planned randomized trials can go a long way in developing a systematic management protocol for postoperative JET.

Incidence and Related Risk Factors of Junctional Ectopic Tachycardia in Infants after Cardiac Surgery for Congenital Heart Disease

“…However, it is difficult to explain the direct association between JET and morality because the cause of death was not related to JET but was associated with other underlying morbidities. Although there have been several previous reports on the association between JET and mortality, the mortality-related postoperative JET showed a decreased incidence in our study compared to that shown in previous reports, which is thought to be due to the improved management of JET [4,15,35,[38][39][40]. Postoperative JET is transient and treatable, but its treatment is often challenging.…”

“…Other factors that could affect the development of JET include electrolyte abnormalities and inotropic drug use [15,35]. In our study, some patients developed electrolyte imbalance immediately after surgery, but we aggressively corrected postoperative electrolyte imbalance.…”

“…In the case of JET that is not controlled by primary treatment, such as sedation, cooling, and correcting electrolyte abnormalities, pharmacotherapy must be used. Amiodarone is the most widely used drug [15,[41][42][43]. Recently, there have been many reports of successful conversion to the sinus rhythm with ivabradine as an adjuvant to amiodarone or a first-line agent in pediatric patients with postoperative JET [15,[44][45][46][47].…”

“…Amiodarone is the most widely used drug [15,[41][42][43]. Recently, there have been many reports of successful conversion to the sinus rhythm with ivabradine as an adjuvant to amiodarone or a first-line agent in pediatric patients with postoperative JET [15,[44][45][46][47]. However, there are insufficient data on the use of ivabradine in pediatric patients.…”

“…Heterotaxy syndrome with a risk of arrhythmia has been reported to be associated with JET [12][13][14]. Several studies have reported possible risk factors for JET, such as younger age, longer cardiopulmonary bypass (CPB) time, longer aortic cross-clamp time, electrolyte disturbances, and use of inotropic agents [2][3][4]6,15]. However, the incidence and related risk factors of JET in neonates and infants after cardiac surgery are not well known.…”