Risk Factors and Outcome of Post Fallot Repair Junctional Ectopic Tachycardia (JET)

Abstract

Background: Junctional ectopic tachycardia (JET) is a common arrhythmia causing hemodynamic impairment following corrective cardiac surgery such as tetralogy of Fallot (TOF) repair. Methods: We report our experience with postoperative JET following surgical repair of TOF. The retrospective study was done from 2003 to 2012 with a total of 105 patients who underwent TOF repair. These patients' clinical and electrocardiographic data (pre-, intra-, and postoperative) were monitored to identify risk factors for the occurrence of JET and to evaluate the outcome of the affected patients. Results: Incidence-Fourteen patients developed JET, with only four patients going directly from sinus rhythm to JET. In all others, either a transient atrioventricular (AV) block or a junctional rhythm preceded JET, mostly intraoperatively, showing a significant relation (P ¼ .010). Age-Patients with JET were of younger age (P ¼ .025) and had longer cardiopulmonary bypass (P ¼ .044) and aortic cross-clamping times (P ¼ .038). Increased cost and care-The occurrence of JET was associated with a longer stay in the intensive care unit (ICU) and a prolonged need for inotropic support and mechanical ventilation. Time to rate control correlated with length of ICU and hospital stay. Mortality: All JET patients converted into sinus rhythm, one of them died shortly after cessation of JET and two patients subsequently developed a first-degree AV block. Conclusion: The occurrence of JET remains an important complication during the initial postoperative period by increasing mechanical ventilation time, the need for inotropic support, and prolonging the length of ICU and hospital stay. Risk factors are younger age, longer aortic cross-clamping/bypass times, and intraoperative arrhythmias.

Junctional ectopic tachycardia in infants and children

“…1,2,20 The risk factors associated with an increased incidence include the age of infant less than 6 months, the postoperative use of dopamine or milrinone, the use of prolonged aortic cross-clamp and cardiopulmonary bypass, and total surgical time. [1][2][3]8,38 The use of nitroprusside was associated with a reduced incidence of JET. 8 The type of cardiac surgery is also a factor, especially those that involve the crux of the heart including tetralogy of Fallot, AV canal, and ventricular septal defect repair, as well as repair of anomalous pulmonary venous return, arterial switch operation, Norwood procedure, and interrupted aortic arch repair.…”

“…8 The type of cardiac surgery is also a factor, especially those that involve the crux of the heart including tetralogy of Fallot, AV canal, and ventricular septal defect repair, as well as repair of anomalous pulmonary venous return, arterial switch operation, Norwood procedure, and interrupted aortic arch repair. 1,20,38 Other risk factors associated are postoperative higher core temperature and imbalances of electrolytes. [39][40][41][42] Of note, all arrhythmias, including JET, are common in those with complex congenital heart disease especially the heterotaxy syndromes but the difficulty in the risk association is that most of these infants have had early surgical interventions.…”

Surgery of Tetralogy of Fallot-15 Year Experience at Afic-Nihd Rawalpindi

“…Left anterior descending artery (LAD) crossed RVOT in 14 (1.79%) of TAP/TV cases and to save LAD in all these cases, right ventricle to pulmonary artery (RV-PA) conduit (Contegra, Medtronic) of 16-20 mm size was implanted, while in TA/TP cases it was not needed (p=0.044). Others report similarly 15 .…”

Intermediate Outcomes of Staged Tetralogy of Fallot Repair

“…This contrasts from reported rates of 19% to 37% of arrhythmia after early complete repair, with the majority having JET, leading to longer mechanical ventilation and intensive care unit stay. 3,11,[24][25][26][27] Bailey et al reported a lower incidence of postoperative arrhythmias in neonates after staged repair when compared to early complete repair (3.6% vs 19%, P ¼ .04). 11 Staged repairs may have lower rates of postoperative arrhythmias, as they may allow for older age, greater weight, and shorter bypass duration at complete repair, potentially improving these variables associated with postoperative arrhythmia.…”