Postoperative junctional ectopic tachycardia (JET)

Haas, Nikolaus A.; Plumpton, Kevin; Justo, Robert; Jalali, Homayoun; Pohlner, Peter

doi:10.1007/s00392-004-0067-3

Cited by 45 publications

(52 citation statements)

References 54 publications

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“…Incidence of JET is highly dependent on the cardiac lesion and specific surgical repair, but patients at highest risk appear to be those with Tetralogy of Fallot (TOF), ventricular septal defects, and atrioventricular (AV) septal defects. 1 Local trauma or surgical irritation near the AV node leads to enhanced automaticity of the cardiac conduction bundle, manifesting as acceleration in heart rate with loss of AV synchrony. 1 JET often develops during the time of peak postoperative cardiac edema, which further compromises ventricular filling and diastolic function.…”

Section: Introductionmentioning

confidence: 99%

“…1 Local trauma or surgical irritation near the AV node leads to enhanced automaticity of the cardiac conduction bundle, manifesting as acceleration in heart rate with loss of AV synchrony. 1 JET often develops during the time of peak postoperative cardiac edema, which further compromises ventricular filling and diastolic function. Due to the recalcitrant nature of JET, amiodarone is often used concurrently with other treatments.…”

Section: Introductionmentioning

confidence: 99%

“…It has shown particular promise in postoperative congenital cardiac patients 2 and is now first-line pharmacologic therapy for critical tachyarrhythmia. 1 Acute hepatotoxicity following intravenous (IV) amiodarone administration has been reported in several collections of adult case studies. [3][4][5] In 2005, Ra¨tz Bravo et al 6 reviewed 25 such adult cases reported between 1986 and 2002.…”

Section: Introductionmentioning

confidence: 99%

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Hepatotoxicity After Continuous Amiodarone Infusion in a Postoperative Cardiac Infant

Kicker

Haizlip

Buck

2012

The Journal of Pediatric Pharmacology and Therapeutics

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A former 34-week-old female infant with Down syndrome underwent surgical correction of a congenital heart defect at 5 months of age. Her postoperative course was complicated by severe pulmonary hypertension and junctional ectopic tachycardia. Following treatment with amiodarone infusion, she developed laboratory indices of acute liver injury. At their peak, liver transaminase levels were 19 to 35 times greater than the upper limit of normal. Transaminitis was accompanied by coagulopathy, hyperammonemia, and high serum lactate and lipid levels. Hepatic laboratory abnormalities began to resolve within 48 hr of stopping amiodarone infusion. Heart rate control was achieved concurrently with discovery of laboratory test result abnormalities, and no further antiarrhythmic therapy was required. The intravenous formulation of amiodarone contains the diluent polysorbate 80, which may have hepatotoxic effects. Specifically, animal studies suggest that polysorbate 80 may destabilize cell membranes and predispose to fatty change within liver architecture. Polysorbate was implicated in infant fatalities from Eferol use in the 1980s. This case illustrates a possible adverse event by the Naranjo probability scale. Given the extent of clinically apparent hepatic injury, this patient was not rechallenged with amiodarone during the remainder of her hospitalization. With amiodarone now used as first-line pharmacologic therapy for critical tachyarrhythmia in this population, the number of children exposed to this drug should be expected to increase. Laboratory indices of liver function should be evaluated at initiation of amiodarone therapy, as well as frequently throughout duration of therapy. Consideration should be given to polysorbate-free formulation of intravenous amiodarone for use in the cohort with congenital cardiac disease.INDEX TERMS amiodarone, congenital heart disease, hepatotoxicity, junctional ectopic tachycardia, polysorbate 80

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hepatotoxicity After Continuous Amiodarone Infusion in a Postoperative Cardiac Infant

Kicker

Haizlip

Buck

2012

The Journal of Pediatric Pharmacology and Therapeutics

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“…While JET is a self-limited arrhythmia that typically resolves within several days, associated increases in heart rate along with loss of atrioventricular synchrony, in the setting of potential systolic or diastolic dysfunction, can be detrimental. Patients who develop JET have increased morbidity, including prolonged ventilation times and intensive care unit stays, and mortality compared to their counterparts without JET 2, 3, 5-8 . Pharmacologic therapy may have adverse hemodynamic effects and is sometimes ineffective, and additional treatments ranging from therapeutic hypothermia to catheter ablation to extracorporeal cardiac support may be required, each with variable efficacy and their own related complications 9 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Background Junctional ectopic tachycardia (JET) is a common arrhythmia complicating pediatric cardiac surgery, with many identifiable clinical risk factors, but no genetic risk factors to date. Objective To test the hypothesis that the angiotensin converting enzyme insertion/deletion (ACE I/D) polymorphism associates with postoperative JET. Methods DNA samples were collected from children undergoing the Norwood procedure, arterial switch operation, and repairs of Tetralogy of Fallot (TOF), balanced atrioventricular septal defect (AVSD), and ventricular septal defect (VSD) at a single center. The incidence of postoperative JET was associated with previously identified clinical risk factors and ACE I/D genotype. Results Of 174 children who underwent the above surgeries, 21% developed JET. Post-operative JET developed in 31% of children with the D/D genotype and only 16% of those with I/I or I/D genotype (p=0.02). Clinical predictors of JET were selected a priori and included age, inotrope score, cardiopulmonary bypass and cross clamp times. Multivariable logistic regression identified a significant correlation between the D/D genotype and postoperative JET independent of these predictors (OR=2.4; 95% CI, 1.04-5.34; p=0.04). A gene-dose effect was apparent in the homogenous subset of AVSD subjects (58% JET in D/D subjects, 12% JET in I/D, and 0% JET in I/I; p<0.01). Conclusion The common ACE deletion polymorphism is associated with a greater than two-fold increase in the odds of developing JET in children undergoing surgical repair of AVSD, TOF, VSD, or Norwood or arterial switch procedures. These findings may support the potential role of the renin-angiotensin-aldosterone system in the etiology of JET.

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“…A case of JET associated with myocarditis, has also been reported [4]. Electrocardiographic diagnosis of JET is made by the presence of AV dissociation in a narrow QRS complex tachycardia at a rate of 170 to 260 beats per minute and JET usually occurs within the first 24 to 48 hours of surgery [5]. Younger children tend to have faster and incessant JET [6].…”

mentioning

confidence: 99%

Junctional Ectopic Tachycardia

Wren

2011

Concise Guide to Pediatric Arrhythmias

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Junctional ectopic tachycardia (JET) often occurs in the setting of surgery for congenital heart disease [1]. A congenital variety of JET not related to any surgery has also been described [2]. While post surgical JET has a mortality upto 14% [1], congenital JET has a mortality upto 34% [3]. A case of JET associated with myocarditis, has also been reported [4]. Electrocardiographic diagnosis of JET is made by the presence of AV dissociation in a narrow QRS complex tachycardia at a rate of 170 to 260 beats per minute and JET usually occurs within the first 24 to 48 hours of surgery [5]. Younger children tend to have faster and incessant JET [6]. JET in the fetus can be diagnosed based on AV dissociation noted in superior vena cava/ascending aorta Doppler flow recordings [7].Mildh et al identified 51 patients with JET among a group of 1001 children undergoing open heart surgery over a 5 year period, an incidence of about 5% [1]. Rekawek J et al also found a similar incidence with 21 cases of JET among 402 children operated for congenital heart disease [8]. 8% incidence of JET among 336 cases were noted by Batra AS et al [9]. Andreasen JB et al reported an incidence of 10.2% of JET among 874 children who underewent corrective cardiac surgery [10].In case of post operative JET, longer cardiopulmonary bypass time, higher body temperature and higher levels of postoperative troponin T or creatine kinase and high inotropic requirement were associated with JET. These patients also needed longer ventilatory support and intensive care, compared to controls matched for the same type of surgery [1,[9][10][11]. Age less than 1 month, history of cardiac failure and an Aristotle score more than 4 were also associated with JET [12].Intravenous infusion of cold saline in addition to surface cooling, to achieve a core temperature of 32-34 ºC was evaluated in a pilot study for the management of post operative JET in 10 patients recently [13]. The median heart rate decreased from 187 beats per minute to 158 beats per minute. They could achieve AV synchrony in all patients, either by restoration of sinus rhythm or successful atrial pacing. Usually atrial pacing will not affect JET, as is demonstated in the case report by Arshi et al [14] in this issue of the journal. Occasionally, extracorporeal mechanical oxygenation is needed to support the circulation until the arrhythmia gets controlled [15].Magnesium supplementation during cardiopulmonary bypass decreased the incidence of JET in a randomized, double blind controlled trial involving 99 children who underwent pediatric cardiac surgery [12].

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Postoperative junctional ectopic tachycardia (JET)

Cited by 45 publications

References 54 publications

Hepatotoxicity After Continuous Amiodarone Infusion in a Postoperative Cardiac Infant

Hepatotoxicity After Continuous Amiodarone Infusion in a Postoperative Cardiac Infant

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

Junctional Ectopic Tachycardia

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