Impact of junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects
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Impact of junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects. / Dodge-Khatami, A; Miller, O I; Anderson, R H; Gil-Jaurena, J M; Goldman, A P; de Leval, M R.
In: EUR J CARDIO-THORAC, Vol. 21, No. 2, 02.2002, p. 255-9.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects
AU - Dodge-Khatami, A
AU - Miller, O I
AU - Anderson, R H
AU - Gil-Jaurena, J M
AU - Goldman, A P
AU - de Leval, M R
PY - 2002/2
Y1 - 2002/2
N2 - OBJECTIVE: To determine the incidence of postoperative junctional ectopic tachycardia (JET), we reviewed 343 consecutive patients undergoing surgery between 1997 and 1999. The impact of this arrhythmia on in-hospital morbidity and our protocol for treatment were assessed.METHODS: We reviewed the postoperative course of patients undergoing surgery for ventricular septal defect (VSD; n=161), tetralogy of Fallot (TOF; n=114), atrioventricular septal defect (AVSD; n=58) and common arterial trunk (n=10). All patients with JET received treatment, in a stepwise manner, beginning with surface cooling, continuous intravenous amiodarone, and/or atrial pacing if the haemodynamics proved unstable. A linear regression model assessed the effect of these treatments upon hours of mechanical ventilation, and stay on the cardiac intensive care unit (CICU).RESULTS: Overall mortality was 2.9% (n=10), with three of these patients having JET and TOF. JET occurred in 37 patients (10.8%), most frequently after TOF repair (21.9%), followed by AVSD (10.3%), VSD (3.7%), and with no occurrence after repair of common arterial trunk. Mean ventilation time increased from 83 to 187 h amongst patients without and with JET patients (P<0.0001). Accordingly, CICU stay increased from 107 to 210 h when JET occurred (P<0.0001). Surface cooling was associated with a prolongation of ventilation and CICU stay, by 74 and 81 h, respectively (P<0.02; P<0.02). Amiodarone prolonged ventilation and CICU stay, respectively, by 274 and 275 h (P<0.05; P<0.06).CONCLUSIONS: Postoperative JET adds considerably to morbidity after congenital cardiac surgery, and is particularly frequent after TOF repair. Aggressive treatment with cooling and/or amiodarone is mandatory, but correlates with increased mechanical ventilation time and CICU stay. Better understanding of the mechanism underlying JET is required to achieve prevention, faster arrhythmic conversion, and reduction of associated in-hospital morbidity.
AB - OBJECTIVE: To determine the incidence of postoperative junctional ectopic tachycardia (JET), we reviewed 343 consecutive patients undergoing surgery between 1997 and 1999. The impact of this arrhythmia on in-hospital morbidity and our protocol for treatment were assessed.METHODS: We reviewed the postoperative course of patients undergoing surgery for ventricular septal defect (VSD; n=161), tetralogy of Fallot (TOF; n=114), atrioventricular septal defect (AVSD; n=58) and common arterial trunk (n=10). All patients with JET received treatment, in a stepwise manner, beginning with surface cooling, continuous intravenous amiodarone, and/or atrial pacing if the haemodynamics proved unstable. A linear regression model assessed the effect of these treatments upon hours of mechanical ventilation, and stay on the cardiac intensive care unit (CICU).RESULTS: Overall mortality was 2.9% (n=10), with three of these patients having JET and TOF. JET occurred in 37 patients (10.8%), most frequently after TOF repair (21.9%), followed by AVSD (10.3%), VSD (3.7%), and with no occurrence after repair of common arterial trunk. Mean ventilation time increased from 83 to 187 h amongst patients without and with JET patients (P<0.0001). Accordingly, CICU stay increased from 107 to 210 h when JET occurred (P<0.0001). Surface cooling was associated with a prolongation of ventilation and CICU stay, by 74 and 81 h, respectively (P<0.02; P<0.02). Amiodarone prolonged ventilation and CICU stay, respectively, by 274 and 275 h (P<0.05; P<0.06).CONCLUSIONS: Postoperative JET adds considerably to morbidity after congenital cardiac surgery, and is particularly frequent after TOF repair. Aggressive treatment with cooling and/or amiodarone is mandatory, but correlates with increased mechanical ventilation time and CICU stay. Better understanding of the mechanism underlying JET is required to achieve prevention, faster arrhythmic conversion, and reduction of associated in-hospital morbidity.
KW - Amiodarone/administration & dosage
KW - Analysis of Variance
KW - Cardiac Pacing, Artificial
KW - Cardiac Surgical Procedures/methods
KW - Child
KW - Child, Preschool
KW - Female
KW - Heart Defects, Congenital/diagnosis
KW - Heart Septal Defects, Ventricular/diagnosis
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Linear Models
KW - Male
KW - Postoperative Complications/mortality
KW - Postoperative Period
KW - Probability
KW - Prognosis
KW - Respiration, Artificial
KW - Retrospective Studies
KW - Risk Assessment
KW - Survival Rate
KW - Tachycardia, Ectopic Junctional/complications
KW - Tetralogy of Fallot/diagnosis
U2 - 10.1016/s1010-7940(01)01089-2
DO - 10.1016/s1010-7940(01)01089-2
M3 - SCORING: Journal article
C2 - 11825732
VL - 21
SP - 255
EP - 259
JO - EUR J CARDIO-THORAC
JF - EUR J CARDIO-THORAC
SN - 1010-7940
IS - 2
ER -
