Pediatric nonpost-operative junctional ectopic tachycardia medical management and interventional therapies.
OBJECTIVE
To determine the outcomes of medical management, pacing, and catheter ablation for the treatment of nonpost-operative junctional ectopic tachycardia (JET) in a pediatric population.


BACKGROUND
Nonpost-operative JET is a rare tachyarrhythmia that is associated with a high rate of morbidity and mortality. Most reports of clinical outcomes were published before the routine use of amiodarone or ablation therapies.


METHODS
This is an international, multicenter retrospective outcome study of pediatric patients treated for nonpost-operative JET.


RESULTS
A total of 94 patients with JET and 5 patients with accelerated junctional rhythm (age 0.8 year, range fetus to 16 years) from 22 institutions were identified. JET patients presenting at age < or =6 months were more likely to have incessant JET and to have faster JET rates. Antiarrhythmic medications were utilized in a majority of JET patients (89%), and of those, amiodarone was the most commonly reported effective agent (60%). Radiofrequency ablation was conducted in 17 patients and cryoablation in 27, with comparable success rates (82% radiofrequency vs. 85% cryoablation, p = 1.0). Atrioventricular junction ablation was required in 3% and pacemaker implantation in 14%. There were 4 (4%) deaths, all in patients presenting at age < or =6 months.


CONCLUSIONS
Patients with nonpost-operative JET have a wide range of clinical presentations, with younger patients demonstrating higher morbidity and mortality. With current medical, ablative, and device therapies, the majority of patients have a good clinical outcome.
Collins
Kathryn K
KK
Department of Pediatrics, Division of Cardiology, The Children's Hospital, 13123 E. 16th Avenue, Aurora, CO 80045, USA. Collins.kathryn@tchden.org
Van Hare
George F
GF
Kertesz
Naomi J
NJ
Law
Ian H
IH
Bar-Cohen
Yaniv
Y
Dubin
Anne M
AM
Etheridge
Susan P
SP
Berul
Charles I
CI
Avari
Jennifer N
JN
Tuzcu
Volkan
V
Sreeram
Narayanswami
N
Schaffer
Michael S
MS
Fournier
Anne
A
Sanatani
Shubhayan
S
Snyder
Christopher S
CS
Smith
Richard T
RT
Arabia
Luis
L
Hamilton
Robert
R
Chun
Terrence
T
Liberman
Leonardo
L
Kakavand
Bahram
B
Paul
Thomas
T
Tanel
Ronn E
RE
D000293:Adolescent; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D017115:Catheter Ablation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D013613:Tachycardia, Ectopic Junctional / Q000628:therapy*
D000889:Anti-Arrhythmia Agents