A genetic contribution to risk for postoperative junctional ectopic tachycardia in children undergoing surgery for congenital heart disease

Borgman, Kristie Y.; Smith, Andrew H.; Owen, Jill; Fish, Frank A.; Kannankeril, Prince J.

doi:10.1016/j.hrthm.2011.06.033

Cited by 31 publications

(21 citation statements)

References 24 publications

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“…Eligibility for the larger cohort study, “Genetic Basis of Arrhythmias in Pediatrics and Congenital Heart Disease,” was defined as patients with congenital heart disease scheduled to undergo a corrective or palliative operative procedure at our institution. (6,7) Enrollment for the larger study began in September, 2007 and is ongoing. Of 1426 potential participants approached for consent, 254 (18%) declined enrollment, and 1 has withdrawn from the study.…”

Section: Methodsmentioning

confidence: 99%

Opioid Use After Cardiac Surgery in Children With Down Syndrome*

Driest

Shah

Marshall

et al. 2013

Pediatric Critical Care Medicine

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OBJECTIVES To determine the cumulative opioid doses administered to patients with Down syndrome (DS) after cardiac surgery and compare them to patients without DS. DESIGN Retrospective, observational, comparative study. SETTING PICU in a university-affiliated, freestanding pediatric teaching hospital. PATIENTS Infants and children who presented to our institution for heart surgery after July 1, 2008, and met the following criteria: 1) no opioid medications for 48 hours prior to surgery, 2) sternotomy approach with primary closure, 3) no additional operative procedures in the 5 days after surgery. All patients with DS were included, and patients without DS with similar age, type of cardiac lesion, and length of surgical procedure were selected in a ~2:1 ratio, blinded to opioid exposure. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinical and demographic data were extracted from electronic medical record data. Univariate analyses and mulitvariate linear regression modeling were performed to determine the influence of DS, patient characteristics, and clinical covariates on weight-adjusted opioid dose. The differences in median cumulative opioid doses between those with DS (n=44) and those without (n=77) were not significant in the first 24 hours [+0.39 mg/kg (95% CI −0.45 to +1.39 mg/kg)] or 96 hours [+0.54 mg/kg (−0.59 to +2.07 mg/kg)] after surgery. Age, cardiac bypass time, benzodiazepines, and neuromuscular blocking agents were significantly correlated with opioid dose, but DS, gender, pain score, creatinine, acetaminophen, NSAIDs, and steroid medications were not. Patients with DS had longer hospital stays; in multivariate analysis, higher opioid exposures in the first 96 hours after surgery and higher peak serum creatinine values correlated with longer hospitalization. CONCLUSIONS This cohort did not provide evidence for opioid resistance in patients with DS. Younger age, longer cardiac bypass time, exposure to benzodiazepines, and neuromuscular blockade did correlate with increased opioid doses after cardiac surgery.

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Section: Methodsmentioning

confidence: 99%

Opioid Use After Cardiac Surgery in Children With Down Syndrome*

Driest

Shah

Marshall

et al. 2013

Pediatric Critical Care Medicine

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“…Risk factors such as dyselectrolytemia, hyperthermia, prolonged cardiopulmonary bypass (CPB) time, and high inotropic score also contribute to postoperative JET [1] [6]- [11]. Borgman KY et al identified that postoperative JET is also caused due to angiotensin-converting enzyme insertion/deletion polymorphism [12]. These infants had a higher risk for World Journal of Cardiovascular Surgery incessant tachycardia and a fatal outcome [3].…”

Section: Discussionmentioning

confidence: 99%

Ivabradine—The Final Crusader for Postoperative Junctional Ectopic Tachycardia, a Case Report with Literature Review

Sahu¹,

Niraghatam²,

Bansal³

et al. 2019

WJCS

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Background: Junctional ectopic tachycardia (JET) is one troublesome supraventricular arrhythmia in postoperative pediatric cardiac surgical patients. Unless treated timely and effectively it may lead to morbidity and even mortality. Aim: To understand the role of Ivabradine in the treatment of JET in postoperative pediatric cardiac surgical patients. Case: We present a postoperative case of complete repair of Tetralogy of Fallot who was in normal sinus rhythm in the preoperative period and developed JET 4 hours later in postoperative period which was persistent despite measures to optimize the internal milieu of the body and conventional antiarrhythmics, that was successfully treated with Ivabradine at a dose of 0.05 mg/kg/12 hourly. Conclusion: Ivabradine can be used to successfully treat postoperative JET in cases of refractory to other antiarrhythmic drugs like Digoxin and Amiodarone.

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“…The present analysis includes subjects reported in our previous investigation of JET, so a secondary multivariate analysis was performed excluding all patients with JET, to confirm the association between the ACE I/D polymorphism and other postoperative tachyarrhythmias. 16 Statistical analysis was performed using SPSS statistical package, version 20.0 (SPSS, Inc., Chicago, IL). The authors had full access to and take full responsibility for the integrity of the data.…”

Section: Methodsmentioning

confidence: 99%

“…13–15 We have previously identified the common angiotensin converting enzyme insertion/deletion (ACE I/D) polymorphism as a significant predictor of postoperative junctional ectopic tachycardia (JET) following specific congenital heart surgeries. 16 However, the potential proarrhythmic effects of renin-angiotensin-aldosterone system (RAAS) derangements are not limited to one arrhythmia substrate, and the ACE I/D polymorphism specifically has also been associated with atrial arrhythmias and postoperative ventricular arrhythmias in adults. 17–19 We therefore tested the hypothesis that this genetic variant (ACE I/D) alters the risk of any tachyarrhythmia following congenital heart surgery, and investigated the effect of preoperative modulation of the RAAS on postoperative tachyarrhythmias.…”

Section: Introductionmentioning

confidence: 99%

A common angiotensin-converting enzyme polymorphism and preoperative angiotensin-converting enzyme inhibition modify risk of tachyarrhythmias after congenital heart surgery

et al. 2014

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Background The angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism is described in association with numerous phenotypes including arrhythmias, and may provide predictive value among pediatric patients undergoing congenital heart surgery. Objective To examine the role of a common polymorphism on postoperative tachyarrhythmias in a large cohort of pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB). Methods Subjects undergoing congenital heart surgery with CPB at our institution were consecutively enrolled from September 2007 through December 2012. In addition to DNA, perioperative clinical data were obtained from subjects. Results Postoperative tachyarrhythmias were documented in 45% of 886 enrollees, and were associated with prolonged mechanical ventilation (p<0.001) and ICU length of stay (p<0.001). ACE I/D was in Hardy-Weinberg equilibrium (19% I/I, 49% I/D, 32% D/D). I/D or D/D genotypes were independently associated with a 60% increase in odds of new tachyarrhythmia (OR 1.6, 95%CI 1.1–2.3, p=0.02). Preoperative ACE inhibitor administration was independently associated with a 47% reduction in odds of postoperative tachyarrhythmia in the entire cohort (OR 0.53, 95%CI 0.32–0.88, p=0.01), driven by a five-fold reduction in tachyarrhythmias among I/I genotype patients (OR 0.19, 95% CI 0.04–0.88, p=0.02). Conclusions The risk of tachyarrhythmias after congenital heart surgery is independently affected by the ACE I/D polymorphism. Preoperative ACE inhibition is associated with a lower risk of postoperative tachyarrhythmias, an antiarrhythmic effect that appears genotype dependent. An understanding of genotype variation may play an important role in the perioperative management of congenital heart surgery.

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A genetic contribution to risk for postoperative junctional ectopic tachycardia in children undergoing surgery for congenital heart disease

Cited by 31 publications

References 24 publications

Opioid Use After Cardiac Surgery in Children With Down Syndrome*

Opioid Use After Cardiac Surgery in Children With Down Syndrome*

Ivabradine—The Final Crusader for Postoperative Junctional Ectopic Tachycardia, a Case Report with Literature Review

A common angiotensin-converting enzyme polymorphism and preoperative angiotensin-converting enzyme inhibition modify risk of tachyarrhythmias after congenital heart surgery

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