Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment.
BACKGROUND
Junctional ectopic tachycardia (JET) occurs commonly after pediatric cardiac operation. The cause of JET is thought to be the result of an injury to the conduction system during the procedure and may be perpetuated by hemodynamic disturbances or postoperative electrolyte disturbances, namely hypomagnesemia. The purpose of this study was to determine perioperative risk factors for the development of JET.


METHODS
Telemetry for each patient admitted to the cardiac intensive care unit from December 1997 through November 1998 for postoperative cardiac surgical care was examined daily for postoperative JET. A nested case-cohort analysis of 33 patients who experienced JET from 594 consecutively monitored patients who underwent cardiac operation was performed. Univariate and multivariate analyses were conducted to determine factors associated with the occurrence of JET.


RESULTS
The age range of patients with JET was 1 day to 10.5 years (median, 1.8 months). Univariate analysis revealed that dopamine or milrinone use postoperatively, longer cardiopulmonary bypass times, and younger age were associated with JET. Multivariate modeling elicited that dopamine use postoperatively (odds ratio, 6.2; p = 0.01) and age less than 6 months (odds ratio, 4.0; p = 0.02) were associated with JET. Only 13 (39%) of the patients with JET received therapeutic interventions.


CONCLUSIONS
Junctional ectopic tachycardia occurred in 33 (5.6%) of 594 patients who underwent cardiac operation during the study period. Postoperative dopamine use and younger age were associated with JET. It may be speculated that dopamine should be discontinued in the presence of postoperative JET.
Hoffman
Timothy M
TM
Division of Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Pennsylvania, USA. thoffman@chi.osu.edu
Bush
David M
DM
Wernovsky
Gil
G
Cohen
Mitchell I
MI
Wieand
Tammy S
TS
Gaynor
J William
JW
Spray
Thomas L
TL
Rhodes
Larry A
LA
D000638:Amiodarone / Q000008:administration & dosage; D002304:Cardiac Pacing, Artificial; D002648:Child; D002675:Child, Preschool; D004298:Dopamine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020105:Milrinone / Q000008:administration & dosage / Q000009:adverse effects; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D013613:Tachycardia, Ectopic Junctional / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy
D020105:Milrinone; D000638:Amiodarone; D004298:Dopamine