Postoperative Junctional Ectopic Tachycardia: Risk Factors for Occurrence in the Modern Surgical Era

Moak, Jeffrey P.; Arias, Patricio; Kaltman, Jonathan R.; Cheng, Yao I.; McCarter, Robert; Hanumanthaiah, Sridhar; Martin, Gerard R.; Jonas, Richard A.

doi:10.1111/pace.12163

Cited by 39 publications

(48 citation statements)

References 30 publications

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“…The dexmedetomidine and control groups differed significantly with regards to several characteristics, many of which are known to affect the incidence of post-operative arrhythmias. 1–3, 6, 7 The subjects in the dexmedetomidine group were older, had a higher BSA, had shorter CPB and cross-clamp times and had lower lactate levels at admission to the PCICU. Although there was no gender mismatch, the dexmedetomidine group had a lower surgical complexity (RACHS-1) category and less use of calcium chloride, dopamine and epinephrine at PCICU admission.…”

Section: Resultsmentioning

confidence: 99%

“…1–3, 6, 7 Variables that demonstrated high collinearity with chosen variables were excluded. Variables were also excluded from the analysis if there were a high number of missing values or too few subjects in one category.…”

Section: Methodsmentioning

confidence: 99%

“…1–4 Post-operative tachyarrhythmias are often poorly tolerated in this patient population, causing significant hemodynamic instability and are associated with increased early post-operative morbidity and mortality. 4–7 The management of these arrhythmias can present a challenge, as antiarrhythmic therapies may be ineffective and/or associated with significant adverse effects.…”

mentioning

confidence: 99%

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Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

Shuplock

Smith

Owen

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background Dexmedetomidine is commonly used after congenital heart surgery and may be associated with a decreased incidence of post-operative tachyarrhythmias. Using a large cohort of patients undergoing congenital heart surgery, we examined for an association between dexmedetomidine use in the immediate post-operative period and subsequent arrhythmia development. Methods and Results A total of 1,593 surgical procedures for congenital heart disease were performed. Dexmedetomidine was administered in the immediate post-operative period after 468 (29%) surgical procedures. Compared to 1,125 controls, the group receiving dexmedetomidine demonstrated significantly fewer tachyarrhythmias (29% vs. 38%, p<0.001), tachyarrhythmias receiving intervention (14% vs. 23%, p<0.001), bradyarrhythmias (18% vs. 22%, p=0.03) and bradyarrhythmias receiving intervention (12% vs. 16%, p=0.04). After propensity score matching with 468 controls, the arrhythmia incidence between groups became similar: tachyarrhythmias (29% vs. 31%, p=0.66), tachyarrhythmias receiving intervention (14% vs. 17%, p=0.16), bradyarrhythmias (18% vs. 15%, p=0.44) and bradyarrhythmias receiving intervention (12% vs. 9%, p=0.17). After excluding controls exposed to dexmedetomidine at a later time in the hospitalization, dexmedetomidine was associated with increased odds of bradyarrhythmias receiving intervention (odds ratio [OR] 2.18, 95% confidence interval (CI) 1.02 – 4.65). Furthermore, there was a dose-dependent increase in the odds of bradyarrhythmias (OR 1.04, 95% CI 1.01 – 1.07) and bradyarrhythmias receiving intervention (OR 1.05, 95% CI 1.01 – 1.08). Conclusions While dexmedetomidine exposure in the immediate post-operative period is not associated with a clinically meaningful difference in the incidence of tachyarrhythmias after congenital heart surgery, it may be associated with increased odds of bradyarrhythmias.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

Shuplock

Smith

Owen

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…JET most commonly occurs in children during the early postoperative period after repair of congenital heart disease 7, 8. It is thought to be related to ischemia/reperfusion or physical injury to the cardiac conduction tissue related to prolonged operative times, and/or surgical trauma to the conduction system 7 .…”

Section: Discussionmentioning

confidence: 99%

“…It is thought to be related to ischemia/reperfusion or physical injury to the cardiac conduction tissue related to prolonged operative times, and/or surgical trauma to the conduction system 7 . JET is seen less often as a congenital arrhythmia, but when present, has a strong association with cardiomegaly and heart failure 9 …”

Section: Discussionmentioning

confidence: 99%

Junctional ectopic tachycardia secondary to myocarditis associated with sudden cardiac arrest

Cunningham

Doroshow

Olivieri

et al. 2017

HeartRhythm Case Reports

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Junctional ectopic tachycardia in infants and children

Kylat

Samson

2019

Journal of Arrhythmia

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Tachyarrhythmias originating in the atrioventricular (AV) node and AV junction including the bundle of His complex (BH) are called junctional tachycardia (JT) or junctional ectopic tachycardia (JET). Congenital JET (CJET) is a rare arrhythmia that occurs in patients without a preceding cardiac surgery and can be refractory to medical therapy and associated with high morbidity and mortality. CJET has a high rate of morbidity and mortality with death occurring in 35% of cases. JET occurring within 72 hours after cardiac surgery is referred to as postoperative JET (POJET) and caused by direct trauma, ischemic, or stretch injury to the AV conduction tissues during surgical repair of congenital heart defects. Focal junctional tachycardia (FJT) is also known as automatic junctional tachycardia and includes paroxysmal or non‐paroxysmal forms. We discuss a staged approach to therapy with improved pharmacological therapies and the use of catheter‐based therapies.

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Postoperative Junctional Ectopic Tachycardia: Risk Factors for Occurrence in the Modern Surgical Era

Abstract: 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.

Cited by 39 publications

References 30 publications

Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

Junctional ectopic tachycardia secondary to myocarditis associated with sudden cardiac arrest

Junctional ectopic tachycardia in infants and children

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