Tratamiento mediante hipotermia de la taquicardia ectópica de la unión tras cirugía cardíaca infantil

Diagnosis and management of junctional ectopic tachycardia in children

“…A Spanish group reported a mortality of 8.3%. [ 34 ] No deaths were reported to be related to JET in other later studies, likely from prompt identification and multipronged management approach. [ 22 28 35 36 ] The etiopathogenesis, diagnosis, and management are reviewed below.…”

“…[ 61 ] As discussed previously, slowing of JET to an acceptable heart rate that allows hemodynamic improvement with atrial or AV sequential pacing is often defined as success of any particular form of therapy for JET.This also highlights the fact that restoring AV synchrony by using different modes of pacing is an integral part of management of JET. [ 25 34 35 36 61 62 63 ] It has been demonstrated that several techniques of individually optimized temporary dual chamber pacing, leading to optimal AV synchrony and/or synchronous ventricular contraction, can be successfully used to improve hemodynamics in patients with heart failure and selected dysrhythmias after congenital heart surgery. [ 64 ] Atrial pacing, AV sequential pacing, R wave synchronized atrial pacing, and paired ventricular pacing are all modalities that can be helpful in achieving hemodynamic stability.…”

“…[ 69 ] It is often used in combination with pharmacotherapy/pacing. [ 32 34 36 61 70 71 72 73 ] In normal subjects, hypothermia reduces cardiac output and oxygen demand and increases systemic vascular resistance. Hence, oxygen supply/demand is unaffected, provided shivering response is abolished by paralysis and mechanical ventilation.…”

“…Hypothermia is induced by application of ice packs, cooling blankets, fans, lavage using cold physiological saline through nasogastric tube or by intravenous induction using cold saline. [ 34 73 ] Cooling is usually done to a core temperature (rectal) of 32°C–34°C for 24–36 h. Lesser degrees of hypothermia can be used in milder cases. Re-warming is started once the patient is stable for at least 24 h. Resolution of arrhythmia is not the criterion for re-warming.…”

“…[ 36 72 73 74 ] Although hypothermia is known to suppress immune response, none of the studies reported an increase in infections; neither did they report metabolic acidosis nor electrolyte imbalances attributable to hypothermia. [ 34 ] Hypothermia is a safe and effective method for reducing tachycardia rate adequate enough to improve hemodynamics.…”