title: Postoperative junctional ectopic tachycardia: risk factors for occurrence in the modern surgical era.
abstract: BACKGROUND
  Postoperative (PO) junctional ectopic tachycardia (JET) can be a life-threatening arrhythmia that follows surgical repair of congenital heart disease (CHD) and results in PO morbidity.
  
  
  METHODS
  We reviewed 750 open heart surgeries (OHS) for CHD performed between January 2005 and February 2009. Kaplan-Meier and Cox proportional hazards model analyses were used to estimate the frequency and evaluate risk factors that might predict JET occurrence.
  
  
  RESULTS
  The patients ranged in age from 1 day to 36.6 years; half were less than 4.8 months at the time of OHS. JET occurred in 115 of 750 (15.3%) OHS. JET was bimodally distributed by age with a peak incidence between 1-2 weeks and 1-3 years. JET occurred more commonly: (1) in specific types of OHS (single ventricle [19.5%] and cono-truncal defects [19.3%]) (P = 0.03); (2) with increased total surgical time (P = 0.001), aortic cross-clamp time (P < 0.001), cardiopulmonary bypass time (P < 0.001); and (3) followed use of inotropic agents (dopamine or milrinone, P < 0.001). JET lengthened intensive care stay by 3 days (P = 0.0001) and increased mortality (+JET [9.6%] vs -JET [4.6%], P = 0.03). In a multiple variable Cox regression model, total surgical time and PO use of milrinone were the best predictors for JET risk. PO administration of nitroprusside decreased risk of JET.
  
  
  CONCLUSIONS
  JET occurred more commonly following OHS associated with prolonged surgical times and PO use of inotropic medications. In contrast to previous reports, our results suggest that mechanical injury to the atrioventricular node area is not strongly associated with JET.
authors.affiliation: Division of Cardiology, Children's National Medical Center, Washington, DC.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Moak
authors.forename: Patricio
authors.initials: P
authors.lastname: Arias
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kaltman
authors.forename: Yao
authors.initials: Y
authors.lastname: Cheng
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.forename: Sridhar
authors.initials: S
authors.lastname: Hanumanthaiah
authors.forename: Gerard R
authors.initials: GR
authors.lastname: Martin
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
mesh_terms: D000293:Adolescent; D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000401:mortality*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013613:Tachycardia, Ectopic Junctional / Q000401:mortality*; D016896:Treatment Outcome; D055815:Young Adult
keywords: cardiopulmonary bypass; congenital heart disease; infants and children; junctional ectopic tachycardia; open heart surgery; vasoactive medications