Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery patients: A systematic review and meta‐analysis

Ghimire, Laxmi V.; Chou, Fu‐Sheng

doi:10.1111/pan.13405

Cited by 19 publications

(13 citation statements)

References 33 publications

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“…Dexmedetomidine was administered in all patients undergoing surgery on induction of anesthesia at the dose of 0.5 μg/kg/min and continued in the postoperative period. 32,33 Junctional ectopic tachycardia was diagnosed in the intensive care unit by standard 12-lead ECG on the basis of criteria described earlier. 16 Atrial lead ECG was done when the diagnosis was in doubt.…”

Section: Methodsmentioning

confidence: 99%

Ivabradine as an Adjunct for Refractory Junctional Ectopic Tachycardia Following Pediatric Cardiac Surgery: A Preliminary Study

Kumar

Tiwari

et al. 2019

World J Pediatr Congenit Heart Surg

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Objectives: Junctional ectopic tachycardia (JET) is a relatively common narrow complex rhythm typically characterized by atrioventricular dissociation or retrograde atrial conduction in a 1:1 pattern. Junctional ectopic tachycardia can be a life-threatening disorder, causing severe hemodynamic compromise and increased morbidity and mortality. The treatment of refractory JET can be very difficult, even with multimodal therapeutic interventions. The purpose of this study was to assess the role of ivabradine in cases of JET refractory to amiodarone and esmolol. Methods: A total of 480 congenital heart surgeries were carried out at our center in 2017. Twenty (4.16%) patients had postoperative JET. Among these, five infants, aged 7 to 12 months (median: 8 months), had refractory JET. These patients (three tetralogy of Fallot, one ventricular septal defect, one complete atrioventricular septal defect) were treated with oral ivabradine in the dose range of 0.1 to 0.2 mg/kg/12 h as an adjunct to amiodarone. Results: All five patients achieved rate reduction and eventual conversion to sinus rhythm. Mean duration to achieve heart rate of <140 bpm after initiation of ivabradine therapy was 16.8 hours (±7.2 hours), while mean duration to achieve sinus rhythm was 31.6 hours (±13.6 hours). No patient had any recurrence of JET. No patient exhibited any hemodynamic derangement nor side effects attributable to oral ivabradine. Conclusion: Oral ivabradine has the potential to be used as an adjunct to amiodarone in the treatment of JET in infants after surgery for congenital heart disease.

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Section: Methodsmentioning

confidence: 99%

Ivabradine as an Adjunct for Refractory Junctional Ectopic Tachycardia Following Pediatric Cardiac Surgery: A Preliminary Study

Kumar

Tiwari

et al. 2019

World J Pediatr Congenit Heart Surg

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“…836 Intraoperative and postoperative administration of dexmedetomidine might reduce the occurrence of postoperative JET. 933, 934 On the other hand, congenital or non-surgical JET might be controlled by single use or combination of amiodarone, β-blocker, and Class IC drug. 927 ▋ 1.3.4 Permanent Junctional Reciprocating Tachycardia Permanent junctional reciprocating tachycardia (PJRT) is a long RP' narrow QRS tachycardia due to a rare form of accessory pathway with decremental conduction properties and usually located in the posteroseptal region of tricuspid annulus.…”

Section: B Pharmacotherapymentioning

confidence: 99%

JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias

Ono

Iwasaki

Akao

et al. 2022

Circ J

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“…In the PICU setting, DEX has been shown to be effective as a prophylactic treatment for junctional ectopic tachycardia (JET) in post-cardiac surgery. A metanalysis of seven randomized controlled trials representing 1616 patients reported a significant reduction in JET, ICU stay, and duration of mechanical ventilation in those who received DEX [128]. Caution should be considered in the long-term use of DEX infusions, as there is a case report which describes supraventricular tachycardia during DEX weaning of a 4-year-old without pre-existing cardiac disease [129].…”

Section: Pediatric Intensive Care Unitmentioning

confidence: 99%

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

Mahmoud

Barbi

Mason

2020

JCM

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Over the past few years, despite the lack of approved pediatric labelling, dexmedetomidine’s (DEX) use has become more prevalent in pediatric clinical practice as well as in research trials. Its respiratory-sparing effects and bioavailability by various routes are only some of the valued features of DEX. In recent years the potential organ-protective effects of DEX, with the possibility for preserving neurocognitive function, has put it in the forefront of clinical and bench research. This comprehensive review focused on the pediatric literature but presents relevant, supporting adult and animal studies in order to detail the recent growing body of literature around the pharmacology, end-organ effects, organ-protective effects, alternative routes of administration, synergetic effects, and clinical applications, with considerations for the future.

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Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery patients: A systematic review and meta‐analysis

Abstract: Prophylactic dexmedetomidine is effective in reducing the incidence of postoperative junctional ectopic tachycardia without significant increases in adverse events in pediatric patients undergoing surgery for congenital heart diseases.

Cited by 19 publications

References 33 publications

Ivabradine as an Adjunct for Refractory Junctional Ectopic Tachycardia Following Pediatric Cardiac Surgery: A Preliminary Study

Ivabradine as an Adjunct for Refractory Junctional Ectopic Tachycardia Following Pediatric Cardiac Surgery: A Preliminary Study

JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

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