Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair

Imamura, Michiaki; Dossey, Amy M.; Garcia, Xiomara; Shinkawa, Takeshi; Jaquiss, Robert D.B.

doi:10.1016/j.jtcvs.2011.09.042

Cited by 31 publications

(19 citation statements)

References 15 publications

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“…While efforts in the immediate postoperative period to mitigate the risk of postoperative tachyarrhythmias have been described, the identification of preoperative risk factors may prove useful in guiding preemptive therapy to reduce potential risk in the early postoperative period. 24–26 Interestingly, in contrast to ACE-inhibition, preoperative beta-blocker therapy was not associated with a decrease in postoperative arrhythmias, but rather an increased incidence. This could be attributable to up-regulation of β-adrenergic receptors with subsequent postoperative exposure to catecholamine infusions.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Bifasicular block can occur in 8%‐12% of patients and complete block in 3%‐5%. Junctional ectopic tachycardia (JET) can occur in 15%‐20% of TOF patients in the early postoperative period …”

Section: Main Articlementioning

confidence: 99%

“…The VSD is large and its subaortic position poses the risk of heart block and potential arrhythmia. Most common is junctional ectopic tachycardia for which dexmedetomidine infusion has been successfully used while also providing sedation or administer amiodorone, along with conservative measures such as cooling and paralysis in symptomatic patients . Early extubation, to improve preload and RV filling, is a desirable postoperative goal.…”

Section: Main Articlementioning

confidence: 99%

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Tetralogy of Fallot: Everything you wanted to know but were afraid to ask

Wise‐Faberowski

Asija

McElhinney

2019

Pediatric Anesthesia

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Summary Tetralogy of Fallot (TOF) has four anatomic features: right ventricular hypertrophy (RVH), ventriculoseptal defect (VSD), overriding aorta and right ventricular outflow tract obstruction (RVOT) with an occurrence of 3.9 /10,000 births. The pathophysiologic effects in TOF are largely determined by the degree of RVOT and not the VSD. Intra‐operative anesthetic management is also dependent on the degree of RVOT obstruction and influenced by the extent of surgical RVOT repair.

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“…Retrograde 1:1 conduction may be most detrimental to hemodynamics as atrial contraction regularly occurs against closed atrioventricular valves. 5 The definition of postoperative JET often is based on a critical heart rate (eg, 170 beats/min) 6 to discriminate between an accelerated junctional rhythm against junctional ectopic tachycardia. Significantly, there is an acceleration phase with an initial increase in frequency of heart rate at the onset of JET.…”

Section: Characteristics Of Postoperative Junctional Ectopic Tachycardiamentioning

confidence: 99%

Strategies for Temporary Cardiac Pacing in Pediatric Patients With Postoperative Junctional Ectopic Tachycardia

Entenmann

Michel

2016

Journal of Cardiothoracic and Vascular Anesthesia

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Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair

Abstract: Prophylactic amiodarone is well tolerated and significantly associated with a decreased incidence of junctional ectopic tachycardia after tetralogy repair.

Cited by 31 publications

References 15 publications

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

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

Tetralogy of Fallot: Everything you wanted to know but were afraid to ask

Strategies for Temporary Cardiac Pacing in Pediatric Patients With Postoperative Junctional Ectopic Tachycardia

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