Junctional Ectopic Tachycardia After Congenital Heart Surgery in the Current Surgical Era

Abstract

To determine the incidence of postoperative junctional ectopic tachycardia (JET) in a modern cohort of pediatric patients, evaluate possible risk factors for JET, and examine the effects of JET on postoperative morbidity and mortality. JET is common after congenital heart surgery. JET-related mortality has been a rare event at our center, which is different from previous reports. We reviewed records for pediatric patients who had postoperative arrhythmias between January 2006 and June 2010 at a large tertiary-care children's hospital. We performed a matched case-control study to identify risk factors for JET and a matched-cohort study to compare outcomes between patients and controls. Whenever possible, each JET case was randomly matched to two controls on the basis of lesion, repair, and surgical period. We identified 54 patients with JET (incidence = 1.4 %). After multivariate logistic regression analysis, low operative weight, cardiopulmonary bypass (CPB) duration >100 min, and immediate postoperative serum lactic acid level >20 mg/dl were associated with increased odds of developing JET. Patients with JET had longer mechanical ventilation time, cardiac intensive care unit (CICU) stay, and hospital stay. There was only one death in JET group (1.8 %) with no significant difference compared with the control group. JET remains a relatively common postoperative arrhythmia, but it is less frequent than previously reported. JET occurs more commonly in smaller patients with longer CPB runs and significant postoperative lactic acidosis levels. Mortality associated with JET is lower than historically reported, but morbidity remains high.

Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot

“…Our JET incidence rate appears lower than the incidence rate of 3% to 10% reported in the literature [16–18]. Andreasen et al [17] and Batra et al [18] reported the incidence rate for JET after congenital heart surgery to be 8% and 10%, respectively [16].…”

“…Our JET incidence rate appears lower than the incidence rate of 3% to 10% reported in the literature [16–18]. Andreasen et al [17] and Batra et al [18] reported the incidence rate for JET after congenital heart surgery to be 8% and 10%, respectively [16]. These studies included lesions such as transposition of great arteries with VSD and Truncus arteriosus, which involve intracardiac repair in the neonatal period.…”

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

“…In the present study, the incidence rate of junctional ectopic tachycardia in group A was 5.7%. This result is in accordance with previous studies, which reported that the incidence rate of junctional ectopic tachycardia after cardiac surgery range from 1.4% to 14.7% 21)22). The relationship between junctional ectopic tachycardia and milrinone use has not been elucidated thus far 23)…”

Factors affecting perioperative mortality in tetralogy of Fallot

“…36,37,40 In a study by Makhoul et al,239 patients developed arrhythmia in the postoperative period out of the 3850 who underwent congenital heart surgery. 41 In this study, a total of 54 patients developed JET (1.4%), and 11 of the 206 patients that underwent TOF repair (5.3%) had JET. In our study, postoperative JET developed in 13 patients (10.6%), a higher rate than previously reported.…”