A prospective analysis of the incidence and risk factors associated with junctional ectopic tachycardia following surgery for congenital heart disease.
This study was designed to evaluate the incidence and risk factors associated with the occurrence of junctional ectopic tachycardia (JET) in patients after congenital heart surgery. We prospectively analyzed cardiac rhythm status in 336 consecutive patients undergoing surgery for congenital heart disease at our institution during a 1-year period. The incidence of JET was 8% (27/336). Repairs with the highest incidence of JET were arterial switch operation (3/13, 23%), atrioventricular (AV) canal repair (4/19, 21%), and Norwood repair (2/10, 20%). Compared to patients with no arrhythmias, patients with JET were more likely to be younger (2.75 +/- 2.44 vs 5.38 +/- 7.25 years, p < 0.01), have had longer cardiopulmonary bypass times (126 +/- 50 vs 85 +/- 73, p < 0.01), and have a higher inotrope score (6.26 +/- 7.55 vs 2.41 +/- 8.11, p < 0.01). By multivariate analysis, ischemic time was the only factor associated with JET [odds ratio, 1.01 (confidence interval, 1.005-1.02); p = 0.0014). The presence of JET did not correlate with electrolyte abnormalities. JET is not necessarily related to surgery near the His bundle or hypomagnesemia. Longer ischemic time is the best predictor of JET. Patients undergoing arterial switch operation, AV canal repair, and Norwood repair are at highest risk of postoperative JET and should be considered for prophylactic therapy.
Batra
A S
AS
Division of Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA. abatra@iupui.edu.
Chun
D S
DS
Division of Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Johnson
T R
TR
Division of Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Maldonado
E M
EM
Division of Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Kashyap
B A
BA
Division of Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Maiers
J
J
Division of Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Lindblade
C L
CL
Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, 702 Barnhill Drive, Indianapolis, IN, 46202, USA.
Rodefeld
M
M
Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, 702 Barnhill Drive, Indianapolis, IN, 46202, USA.
Brown
J W
JW
Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, 702 Barnhill Drive, Indianapolis, IN, 46202, USA.
Hubbard
J E
JE
Division of Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D004573:Electrolytes / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000502:physiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013613:Tachycardia, Ectopic Junctional / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology
D004573:Electrolytes