title: Junctional ectopic tachycardia after congenital heart surgery in the current surgical era.
abstract: To determine the incidence of postoperative junctional ectopic tachycardia (JET) in a modern cohort of pediatric patients, evaluate possible risk factors for JET, and examine the effects of JET on postoperative morbidity and mortality. JET is common after congenital heart surgery. JET-related mortality has been a rare event at our center, which is different from previous reports. We reviewed records for pediatric patients who had postoperative arrhythmias between January 2006 and June 2010 at a large tertiary-care children's hospital. We performed a matched case-control study to identify risk factors for JET and a matched-cohort study to compare outcomes between patients and controls. Whenever possible, each JET case was randomly matched to two controls on the basis of lesion, repair, and surgical period. We identified 54 patients with JET (incidence = 1.4 %). After multivariate logistic regression analysis, low operative weight, cardiopulmonary bypass (CPB) duration >100 min, and immediate postoperative serum lactic acid level >20 mg/dl were associated with increased odds of developing JET. Patients with JET had longer mechanical ventilation time, cardiac intensive care unit (CICU) stay, and hospital stay. There was only one death in JET group (1.8 %) with no significant difference compared with the control group. JET remains a relatively common postoperative arrhythmia, but it is less frequent than previously reported. JET occurs more commonly in smaller patients with longer CPB runs and significant postoperative lactic acidosis levels. Mortality associated with JET is lower than historically reported, but morbidity remains high.
authors.affiliation: Pediatric Cardiology Division, Children's Healthcare of Atlanta at Egleston, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, USA. majdmak@hotmail.com
authors.forename: Majd
authors.initials: M
authors.lastname: Makhoul
authors.forename: Matthew
authors.initials: M
authors.lastname: Oster
authors.forename: Peter
authors.initials: P
authors.lastname: Fischbach
authors.forename: Srikant
authors.initials: S
authors.lastname: Das
authors.forename: Shriprasad
authors.initials: S
authors.lastname: Deshpande
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013613:Tachycardia, Ectopic Junctional / Q000453:epidemiology* / Q000209:etiology