Junctional ectopic tachycardia after surgery for congenital heart disease: incidence, risk factors and outcome.
OBJECTIVE
Junctional ectopic tachycardia (JET) is a serious, haemodynamically compromising tachyarrhythmia associated with paediatric cardiac surgery, with a reported mortality up to 14%. The incidence, risk factors and outcome of this tachyarrhythmia were evaluated in this population-based, case-control patient cohort.


METHODS
A total of 1001 children, who underwent open-heart surgery during a 5-year period, were retrospectively analysed. The patients with haemodynamically significant tachycardia were identified, and their postoperative electrocardiograms were analysed. Three controls matched with the same type of surgery were selected for each patient with JET.


RESULTS
JET was diagnosed in 51 patients (5.0%). These patients had longer cardiopulmonary bypass time (138 vs 119 min, p=0.002), higher body temperature (38.0 vs 37.4 °C, p=0.013) and higher level of postoperative troponin-T (3.7 vs 2.1 μg l(-1), p<0.001) compared with controls. They also needed longer ventilatory support (3 vs 2 days, p=0.004) and intensive care stay (7 vs 5 days, p<0.001) as well as use of noradrenaline (23/51 vs 35/130, p=0.019). Ventricular septal defect (VSD) closure was part of the surgery in 33/51 (64.7%) of these patients. The mortality was 8% in the JET group and 5% in the controls (p=0.066). In the logistic regression model, JET was not an independent risk factor for death (p=0.557).


CONCLUSIONS
The incidence of JET was 5.0% in this large paediatric open-heart surgery patient group. Compared with controls, these patients had longer cardiopulmonary bypass time and higher level of troponin-T, possibly reflecting the extent of surgical trauma. However, the tachycardia was not an independent risk factor for death.
Mildh
Leena
L
Department of Anaesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland. leena.mildh@hus.fi
Hiippala
Anita
A
Rautiainen
Paula
P
Pettilä
Ville
V
Sairanen
Heikki
H
Happonen
Juha-Matti
JM
D015415:Biomarkers / Q000097:blood; D001831:Body Temperature; D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005260:Female; D005387:Finland / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D013613:Tachycardia, Ectopic Junctional / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D020107:Troponin T