Safety and Efficacy of Prophylactic Amiodarone in Preventing Early Junctional Ectopic Tachycardia (JET) in Children After Cardiac Surgery and Determination of Its Risk Factor

Abstract

Postoperative arrhythmia is a common complication after open heart surgery in children. JET is the most common and dangerous arrhythmia. We aimed to assess safety and efficacy of prophylactic amiodarone in preventing JET in children underwent cardiac surgery and to assess risk factors for JET among our patients. In total, 117 children who underwent cardiac surgery for CHD at Tanta University Hospital from October 2011 to April 2015 were divided in two groups; amiodarone group (65 patients) was given prophylactic amiodarone intraoperatively and placebo group (52 patients). Amiodarone is started as loading dose of 5 mg/kg IV in the operating room after induction of anesthesia and continued for 3 days as continuous infusion 10-15 μg/kg/min. Primary outcome and secondary outcomes of amiodarone administration were reported. We studied pre-, intra- and postoperative factors to determine risk factors for occurrence of JET among these children. Prophylactic amiodarone was found to significantly decrease incidence of postoperative JET from 28.9 % in placebo group to 9.2 % in amiodarone group, and symptomatic JET from 11.5 % in placebo group to 3.1 % in amiodarone group, and shorten postoperative intensive care unit and hospital stay without significant side effects. Risk factors for occurrence of JET were younger age, lower body weight, longer cardiopulmonary bypass, aortic cross-clamp time, hypokalemia, hypomagnesemia, acidosis and high dose of inotropes. JET was more associated with surgical repair of right ventricular outlet obstruction as in case of tetralogy of Fallot and pulmonary stenosis. Most of JET 15/21 (71.4 %) occurred in the first day postoperatively, and 6/21 occurred in the second day (28.6 %). Prophylactic amiodarone is safe and effective in preventing early JET in children after open heart surgery.

Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery

“…Many treatment protocols were used to treat postoperative JET, such as the use of digoxin, propranolol, amiodarone, hypothermia, flecainide, and magnesium sulphate . Although it is better to prevent JET, none of the current medications are useful in preventing or reducing its incidence after pediatric cardiac surgery except amiodarone, which was studied in our previous study and proved to be effective in preventing JET in children after cardiac surgery …”

Efficacy of dexmedetomidine in prevention of junctional ectopic tachycardia and acute kidney injury after pediatric cardiac surgery: A meta‐analysis

“…Several therapeutic protocols have been shown to be effective for the treatment of postoperative JET such as the use of beta‐blockers, hypothermia (maintaining core temperature approximately 35°C), and magnesium sulfate, but prevention of the condition is the ideal. To our knowledge, with the exception of amiodarone, there are currently few medications that can prevent or decrease the occurrence of JET after pediatric cardiac surgery …”

“…For this arrhythmia, several treatments have been employed in different pediatric centers, such as the use of beta‐blockers, flecainide, magnesium sulfate, or hypothermia, and have been proven to be effective . However, few of the current medications are ideal in preventing or reducing the occurrence of JET after pediatric cardiac surgery with the exception of amiodarone …”

“…2,6,7 However, few of the current medications are ideal in preventing or reducing the occurrence of JET after pediatric cardiac surgery with the exception of amiodarone. 8 Acute kidney injury (AKI) is also a serious complication in pediatric patients undergoing cardiac surgery with the use of cardiopulmonary bypass (CPB). The exact pathogenesis of AKI remains unclear but involves multiple pathways.…”

Junctional ectopic tachycardia after tetralogy of Fallot repair in children: frequency, risk factors and outputs

“…возраст пациента менее 6 мес являлся фактором риска УЭТ (p <0,001) [14], как и в работе D.E. Amrousy et al [18]. По полученным нами результатам, ранний возраст также увеличивал риск развития УЭТ.…”