Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair.
OBJECTIVE
Junctional ectopic tachycardia is common after pediatric heart surgery. After tetralogy of Fallot repair, the incidence of junctional ectopic tachycardia may be as high as 15% to 20%. We introduced prophylactic amiodarone for tetralogy repair. This study was conducted to evaluate the effectiveness of the prophylactic amiodarone.


METHODS
A continuous infusion of amiodarone was started in the operating room at the time of rewarming during cardiopulmonary bypass at a rate of 2 mg/kg/d and continued for 48 hours. Between November 2005 and November 2009, 63 consecutive patients underwent primary repair of tetralogy, of whom 20 had prophylactic amiodarone (amiodarone group) and 43 did not (control group). Variables studied included demographic and bypass data, surgical procedure details (transannular or nontransannular patch), preoperative and postoperative echocardiography findings, and postoperative inotropic support. Univariate and stepwise multivariate analyses were conducted to determine factors associated with the occurrence of junctional ectopic tachycardia.


RESULTS
The incidence of junctional ectopic tachycardia was 37% in the control group and 10% in the amiodarone group. The groups were similar in age, weight, bypass time, rate of transannular patch usage, and preoperative and postoperative gradient through the right ventricular outflow tract. Prophylactic amiodarone was significantly negatively associated with junctional ectopic tachycardia by both univariate (P = .039) and multivariate (P = .027) analyses. There were no adverse events attributable to prophylactic amiodarone use.


CONCLUSIONS
Prophylactic amiodarone is well tolerated and significantly associated with a decreased incidence of junctional ectopic tachycardia after tetralogy repair.
University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Department of Surgery, Little Rock, Ark 72202, USA. ImamuraMichiaki@uams.edu
Michiaki
M
Imamura
Amy M
AM
Dossey
Xiomara
X
Garcia
Takeshi
T
Shinkawa
Robert D B
RD
Jaquiss
D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013613:Tachycardia, Ectopic Junctional / Q000209:etiology / Q000517:prevention & control*; D013771:Tetralogy of Fallot / Q000601:surgery*
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone