Postoperative junctional ectopic tachycardia (JET).
Postoperative junctional ectopic tachycardia (JET) is a potential life-threatening tachycardia that mainly occurs after surgical correction of congenital heart defects. The arrhythmia itself or the related treatment has significant clinical impact on the postoperative course and intensive care stay. In general, JET is a self-limiting disorder that usually resolves within one week. However, JET occurs usually within the first 24 to 48 hours after corrective surgery, when systolic and diastolic function of the heart is impaired. Thus, the rapid heart rate leads to an acute further deterioration of cardiac output that requires adequate treatment. The diagnosis of JET is made by the typical ECG-appearance with narrow QRS-configuration at a rate of 170 to 260 bpm and AV-dissociation. A variety of different therapeutic strategies have been tested in postoperative and congenital/spontaneous JET. Treatment success is usually defined as a stable decrease in the ventricular rate below 140-150/min, the possibility of atrial pacing and thereby the improvement of cardiac output. Optimal success is the reinstitution of sinus rhythm. Many of the treatment strategies reported are based on specific institutional treatment protocols. These include conventional supportive treatment, specific medical antiarrhythmic therapy, specific forms of pacing and surface cooling. Today, the administration of high doses of amiodarone usually leads to adequate control of the rate and enables pacing. Surgical intervention or catheter ablation of the HIS-bundle is rarely necessary. This article reviews the literature about JET over the past years and offers a specific treatment protocol.
Haas
N A
NA
Paediatric Intensive Care Unit, The Prince Charles Hospital, Brisbane Rode Road, Chermside, Qld 4032, Australia. nikolaus_haas@health.qld.gov.au
Plumpton
K
K
Justo
R
R
Jalali
H
H
Pohlner
P
P
D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D010346:Patient Care Management / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D013613:Tachycardia, Ectopic Junctional / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone