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Kim ME, Baskar S, Janson CM, Chandler SF, Whitehill RD, Dionne A, Law MA, Domnina Y, Smith-Parrish MN, Bird GL, Banerjee M, Zhang W, Reichle G, Schumacher KR, Czosek RJ, Morales DLS, Alten JA. Epidemiology of Postoperative Junctional Ectopic Tachycardia in Infants Undergoing Cardiac Surgery. Ann Thorac Surg 2024; 117:1178-1185. [PMID: 38484909 DOI: 10.1016/j.athoracsur.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/28/2024] [Accepted: 03/04/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Junctional ectopic tachycardia (JET) complicates congenital heart surgery in 2% to 8.3% of cases. JET is associated with postoperative morbidity in single-center studies. We used the Pediatric Cardiac Critical Care Consortium data registry to provide a multicenter epidemiologic description of treated JET. METHODS This is a retrospective study (February 2019-August 2022) of patients with treated JET. Inclusion criteria were (1) <12 months old at the index operation, and (2) treated for JET <72 hours after surgery. Diagnosis was defined by receiving treatment (pacing, cooling, and medications). A multilevel logistic regression analysis with hospital random effect identified JET risk factors. Impact of JET on outcomes was estimated by margins/attributable risk analysis using previous risk-adjustment models. RESULTS Among 24,073 patients from 63 centers, 1436 (6.0%) were treated for JET with significant center variability (0% to 17.9%). Median time to onset was 3.4 hours, with 34% present on admission. Median duration was 2 days (interquartile range, 1-4 days). Tetralogy of Fallot, atrioventricular canal, and ventricular septal defect repair represented >50% of JET. Patient characteristics independently associated with JET included neonatal age, Asian race, cardiopulmonary bypass time, open sternum, and early postoperative inotropic agents. JET was associated with increased risk-adjusted durations of mechanical ventilation (incidence rate ratio, 1.6; 95% CI, 1.5-1.7) and intensive care unit length of stay (incidence rate ratio, 1.3; 95% CI, 1.2-1.3), but not mortality. CONCLUSIONS JET is treated in 6% of patients with substantial center variability. JET contributes to increased use of postoperative resources. High center variability warrants further study to identify potential modifiable factors that could serve as targets for improvement efforts to ameliorate deleterious outcomes.
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Affiliation(s)
- Michael E Kim
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Shankar Baskar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher M Janson
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Robert D Whitehill
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Mark A Law
- Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yuliya Domnina
- Department of Cardiac Critical Care, Children's National Hospital, Washington, DC
| | - Melissa N Smith-Parrish
- Department of Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Geoffrey L Bird
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mousumi Banerjee
- Department of Cardiology, C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan
| | - Wenying Zhang
- Department of Cardiology, C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan
| | - Garrett Reichle
- Department of Cardiology, C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan
| | - Kurt R Schumacher
- Department of Cardiology, C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan
| | - Richard J Czosek
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey A Alten
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Ganea G, Cinteză EE, Filip C, Iancu MA, Balta MD, Vătășescu R, Vasile CM, Cîrstoveanu C, Bălgrădean M. Postoperative Cardiac Arrhythmias in Pediatric and Neonatal Patients with Congenital Heart Disease-A Narrative Review. Life (Basel) 2023; 13:2278. [PMID: 38137879 PMCID: PMC10744555 DOI: 10.3390/life13122278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiac arrhythmias are a frequent complication in the evolution of patients with congenital heart disease. Corrective surgery for these malformations is an additional predisposition to the appearance of arrhythmias. Several factors related to the patient, as well as to the therapeutic management, are involved in the etiopathogenesis of cardiac arrhythmias occurring post-operatively. The risk of arrhythmias in the immediate postoperative period is correlated with the patient's young age and low weight at surgery. The change in heart geometry, hemodynamic stress, and post-surgical scars represent the main etiopathogenic factors that can contribute to the occurrence of cardiac arrhythmias in the population of patients with operated-on congenital heart malformations. Clinical manifestations differ depending on the duration of the arrhythmia, underlying structural defects, hemodynamic conditions, and comorbidities. The accurate diagnosis and the establishment of specific management options strongly influence the morbidity and mortality associated with arrhythmias. As such, identifying the risk factors for the occurrence of cardiac arrhythmias in the case of each patient is essential to establish a specific follow-up and management plan to improve the life expectancy and quality of life of children.
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Affiliation(s)
- Gabriela Ganea
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Eliza Elena Cinteză
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Mihaela Adela Iancu
- Department of Internal Medicine, Family Medicine and Labor Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Alessandrescu-Rusescu” National Institute for Mother and Child Health, 20382 Bucharest, Romania
| | - Mihaela Daniela Balta
- Department of Internal Medicine, Family Medicine and Labor Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Alessandrescu-Rusescu” National Institute for Mother and Child Health, 20382 Bucharest, Romania
| | - Radu Vătășescu
- Emergency Clinical Hospital, 014461 Bucharest, Romania
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France;
| | - Cătălin Cîrstoveanu
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Neonatal Intensive Care Unit, M.S. Curie Children’s Clinical Hospital, 041451 Bucharest, Romania
| | - Mihaela Bălgrădean
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
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3
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Dasgupta S, Shalhoub K, El-Assaad I, O'Leary E, Feins EN, Triedman JK, Walsh EP, Kheir JN, Dionne A. Clinical risk prediction score for post-operative accelerated junctional rhythm and junctional ectopic tachycardia in children with congenital heart disease. Heart Rhythm 2023:S1547-5271(23)00221-7. [PMID: 36898471 DOI: 10.1016/j.hrthm.2023.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Accelerated junctional rhythm (AJR) and Junctional ectopic tachycardia (JET) are common post-operative arrhythmias associated with morbidity/mortality. Studies suggest that pre- or intra-operative treatment may improve outcomes, but patient selection remains a challenge. OBJECTIVES Our objective was to describe contemporary outcomes of post-operative AJR/JET and develop a risk-prediction score to identify patients at highest risk. METHODS Retrospective cohort study of children 0-18 years undergoing cardiac surgery (2011-2018). AJR was defined as usual complex tachycardia with ≥1:1 ventricular-atrial association and junctional rate >25th percentile of sinus rate for age but < 170 bpm while JET was defined as a rate >170 bpm. A risk prediction score was developed using random forest analysis and logistic regression. RESULTS From 6364 surgeries, AJR occurred in 215 (3.4%) and JET in 59 (0.9%). Age, heterotaxy syndrome, aortic cross-clamp time, ventricular septal defect closure and atrio-ventricular canal repair were independent predictors of AJR/JET on multivariate analysis and included in the risk prediction score. The model accurately predicted the risk of AJR/JET with a C-index of 0.72 [95% CI 0.70, 0.75]. Post-operative AJR and JET was associated with prolonged ICU and hospital length of stay, but not with early mortality. CONCLUSION We describe a novel risk prediction score to estimate the risk of post-operative AJR/JET permitting early identification of at-risk patients who may benefit from prophylactic treatment.
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Affiliation(s)
- Soham Dasgupta
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Khairy Shalhoub
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Iqbal El-Assaad
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Edward O'Leary
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Eric N Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - John N Kheir
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
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Wadile S, Sivakumar K, Murmu UC, Ganesan S, Dhandayuthapani GG, Agarwal R, Sheriff EA, Varghese R. Randomized controlled trial to evaluate the effect of prophylactic amiodarone versus dexmedetomidine on reducing the incidence of postoperative junctional ectopic tachycardia after pediatric open heart surgery. Ann Pediatr Cardiol 2023; 16:4-10. [PMID: 37287843 PMCID: PMC10243657 DOI: 10.4103/apc.apc_150_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 06/09/2023] Open
Abstract
Background Junctional ectopic tachycardia (JET) is the most common arrhythmia after pediatric open-heart surgeries (OHS), causing high morbidity and mortality. As diagnosis is often missed in patients with minimal hemodynamic instability, its incidence depends on active surveillance. A prospective randomized trial evaluated the efficacy and safety of prophylactic amiodarone and dexmedetomidine to prevent and control postoperative JET. Methods Consecutive patients aged under 12 years were randomized into amiodarone, dexmedetomidine (initiated during anesthetic induction) and control groups. Outcome measures included incidence of JET, inotropic score, ventilation, and intensive care unit (ICU) duration and hospital stay, as well as adverse drug effects. Results Two hundred and twenty-five consecutive patients with a median age of 9 months (range 2 days-144 months) and a median weight of 6.3 kg (range 1.8 kg-38 kg) were randomized with 70 patients each to amiodarone and dexmedetomidine groups, and the rest were controls. Ventricular septal defect and Fallot's tetralogy were the common defects. The overall incidence of JET was 16.4%. Syndromic patients, hypokalemia, hypomagnesemia, longer bypass, and cross-clamp duration were the risk factors for JET. Patients with JET had significantly prolonged ventilation (P = 0.043), longer ICU (P = 0.004), and hospital stay (P = 0.034) than those without JET. JET was less frequent in amiodarone (8.5%) and dexmedetomidine (14.2%) groups compared to controls (24.7%) (P = 0.022). Patients receiving amiodarone and dexmedetomidine had significantly lower inotropic requirements, lower ventilation duration (P = 0.008), ICU (P = 0.006), and hospital stay (P = 0.05). Adverse effects such as bradycardia and hypotension after amiodarone and ventricular dysfunction after dexmedetomidine were not significantly different from controls. Conclusion Prophylactic amiodarone or dexmedetomidine started before OHS is effective and safe for the prevention of postoperative JET.
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Affiliation(s)
- Santosh Wadile
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Udaya Charan Murmu
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Selvakumar Ganesan
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Giridhar Gopal Dhandayuthapani
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Ravi Agarwal
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Ejaz Ahamed Sheriff
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Roy Varghese
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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Joye R, Beghetti M, Wacker J, Malaspinas I, Bouhabib M, Polito A, Bordessoule A, Shah DC. Early and Late Postoperative Tachyarrhythmias in Children and Young Adults Undergoing Congenital Heart Disease Surgery. Pediatr Cardiol 2023; 44:312-324. [PMID: 36517587 PMCID: PMC9894958 DOI: 10.1007/s00246-022-03074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
The population of patients with congenital heart disease is constantly growing with an increasing number of individuals reaching adulthood. A significant proportion of these children and young adults will suffer from tachyarrhythmias due to the abnormal anatomy, the hemodynamic burden, or as a sequela of surgical treatment. Depending on the underlying mechanism, arrhythmias may arise in the early postoperative period (hours to days after surgery) or in the late postoperative period (usually years after surgery). A good understanding of the electrophysiological characteristics and pathophysiological mechanisms is therefore crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, risk factors, pathophysiological insights, electrophysiological features, and therapy regarding tachyarrhythmias in children and young adults undergoing reparative surgery for congenital heart disease. The evolution and latest data on treatment options, including pharmacological therapy, ablation procedures, device therapy decision, and thromboprophylaxis, are summarized. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.
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Affiliation(s)
- Raphael Joye
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland.
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Iliona Malaspinas
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Maya Bouhabib
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Angelo Polito
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Alice Bordessoule
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Dipen C Shah
- Electrophysiology Unit, Cardiology Division, Geneva University Hospital, Geneva, Switzerland
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Routine Perioperative Esmolol After Infant Tetralogy of Fallot Repair: Single-Center Retrospective Study of Hemodynamics. Pediatr Crit Care Med 2022; 23:e583-e589. [PMID: 36200768 DOI: 10.1097/pcc.0000000000003088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Currently, surgical repair of tetralogy of Fallot (TOF) is associated with an 1.1% 30-day mortality rate. Those with junctional ectopic tachycardia (JET) and restrictive right ventricular physiology have poorer outcomes. Routine postoperative adrenergic or inodilator therapy has been reported, while beta-blockade following cardiopulmonary bypass has not. This study evaluated routine perioperative treatment with esmolol in infants undergoing TOF repair. DESIGN Retrospective chart review of the perioperative course following TOF repair. SETTING Single-center case series describing perioperative management of TOF in a cardiac ICU. PATIENTS This study reviewed all patients less than 18 months old who underwent TOF repair, excluding cases of TOF with absent pulmonary valve or atrioventricular septal defect, at our institution from June 2018 to April 2021. INTERVENTIONS This review investigates the hemodynamic effects of esmolol following cardiopulmonary bypass for TOF repair. MEASUREMENTS AND MAIN RESULTS Preoperative clinical characteristics and perioperative course were extracted from the medical record. Descriptive statistics were used. Twenty-six patients receiving perioperative esmolol after TOF repair were identified and included. Postoperative hemodynamic parameters were within a narrow range with minimal vasoactive support in most patients. Three of 26 patients experienced JET, and one of 26 of whom had a brief cardiac arrest. Median and interquartile range (IQR) for hospital and postoperative length of stay was 7 days (IQR, 6-9 d) and 6 days (IQR, 5-8 d), respectively. There were no 30-day or 1-year mortalities. CONCLUSIONS In this infant cohort, our experience is that the routine use of postoperative esmolol is associated with good cardiac output with minimal requirement for vasoactive support in most patients. We believe optimal postoperative management of infant TOF repair requires a meticulous multidisciplinary approach, which in our experience is enhanced with routine postoperative esmolol treatment.
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Predictors of short versus prolonged PCICU stay after primary repair of tetralogy of Fallot at a tertiary care unit, Karachi: A single-center study. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dumeny L, Chantra M, Langaee T, Duong BQ, Zambrano DH, Han F, Lopez‐Colon D, Humma JF, Dacosta J, Lovato T, Mei C, Duarte JD, Johnson JA, Peek GJ, Jacobs JP, Bleiweis MS, Cavallari LH. β1-receptor polymorphisms and junctional ectopic tachycardia in children after cardiac surgery. Clin Transl Sci 2022; 15:619-625. [PMID: 34713976 PMCID: PMC8932827 DOI: 10.1111/cts.13178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 01/22/2023] Open
Abstract
Junctional ectopic tachycardia (JET) is a potentially life-threatening postoperative arrhythmia in children with specific congenital heart defects and can contribute significantly to postoperative morbidity for at-risk populations. In adults, β1-adrenergic receptor (ADRB1) and β2-adrenergic receptor (ADRB2) genotypes have been associated with increased risk for arrhythmias. However, their association with arrhythmia risk in children is unknown. We aimed to test associations between ADRB1 and ADRB2 genotypes and postoperative JET in patients with congenital heart defects. Children who underwent cardiac surgery were genotyped for the ADRB1 p.Ser49Gly (rs1801252; c.145A>G), p.Arg389Gly (rs1801253; c.1165C>G), ADRB2 p.Arg16Gly (rs1042713; c.46A>G), and p.Glu27Gln (rs1042714; c.79G>C) polymorphisms. The occurrence of postoperative JET was assessed via cardiologist-interpreted electrocardiograms. Genotype associations with JET were analyzed via logistic regression, adjusted for clinical variables associated with JET, with separate analysis in patients not on a β-blocker. Of the 343 children included (median age 8 months, 53% boys, 69% European ancestry), 45 (13%) developed JET. The Arg389Arg genotype was not significantly associated with JET in the overall population (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 0.96-4.03, p = 0.064), but was nominally associated in patients not taking a β-blocker (n = 324, OR = 2.25, 95% CI = 1.05-4.80. p = 0.034). None of the other variants were associated with JET. These data suggest that the ADRB1 Arg389Arg genotype may predict risk for JET following cardiac surgery in pediatric patients in the absence of β-blockade. Whether treatment with a β-blocker ameliorates this association requires further research.
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Affiliation(s)
- Leanne Dumeny
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Marut Chantra
- Division of Pediatric Critical CareDepartments of PediatricsCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA,Present address:
Division of Pediatric Critical Care MedicineDepartment of PediatricsFaculty of Medicine Ramathibodi HospitalMahidol UniversityRatchatewi, BangkokThailand
| | - Taimour Langaee
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Benjamin Q. Duong
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA,Present address:
Precision MedicineNemours Children’s HealthWilmingtonDelawareUSA
| | - Daniel H. Zambrano
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Frank Han
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Dalia Lopez‐Colon
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - James F. Humma
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Jonathan Dacosta
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Tommie Lovato
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Connie Mei
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Julio D. Duarte
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Giles J. Peek
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Jeffrey P. Jacobs
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Mark S. Bleiweis
- Division of Cardiovascular SurgeryDepartments of Surgery and PediatricsCongenital Heart CenterCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational ResearchCenter for Pharmacogenomics and Precision MedicineCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
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Wang Q, Chen C, Wang L. Efficacy and safety of dexmedetomidine in maintaining hemodynamic stability in pediatric cardiac surgery: a systematic review and meta-analysis. J Pediatr (Rio J) 2022; 98:15-25. [PMID: 34252370 PMCID: PMC9432289 DOI: 10.1016/j.jped.2021.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Dexmedetomidine (DEX) is a highly selective alpha-2 adrenergic receptor agonist, which is the main sedative in the intensive care unit. This study aims to investigate the effectiveness and adverse events of DEX in maintaining hemodynamic stability in pediatric cardiac surgery. SOURCES Databases such as PubMed, Cochrane, Web of Science, WANFANG STATA and China National Knowledge Infrastructure were searched for articles about the application of DEX in maintaining hemodynamic stability during and after pediatric cardiac surgery up to 18th Feb. 2021. Only randomized controlled trials were included and random-effects model meta-analysis was applied to calculate the standardized mean deviation (SMD), odds ratio (OR) and 95% confidence interval (CI). SUMMARY OF THE FINDINGS Fifteen articles were included for this meta-analysis, and 9 articles for qualitative analysis. The results showed that preoperative prophylaxis and postoperative recovery of DEX in pediatric patients undergoing cardiac surgery were effective in maintaining systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and reducing heart rate (HR) (SBP: SMD = -0.35,95% CI: -0.72, 0.01; MAP: SMD = -0.83, 95% CI: -1.87,0.21; DBP: SMD = -0.79,95% CI: -1.66,0.08; HR: SMD = -1.71,95% CI: -2.29, -1.13). In addition, the frequency of Junctional Ectopic Tachycardia in the DEX treatment group was lower than that in the placebo group. CONCLUSIONS The application of DEX for preoperative prophylaxis and postoperative recovery in pediatric cardiac surgery patients are effective in maintaining hemodynamic stability, and the clinical dose of DEX is not significantly related to the occurrence of pediatric adverse events which may be related to individual differences.
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Affiliation(s)
- Qing Wang
- Hainan Women and Children's Medical Center, Department of Anesthesiology, Haikou, China
| | - Chuikai Chen
- Hainan Women and Children's Medical Center, Department of Anesthesiology, Haikou, China
| | - Li Wang
- The First Hospital of Hebei Medical University, Department of Anesthesiology, Shijiazhuang, China.
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Arvind B, Kothari SS, Juneja R, Saxena A, Ramakrishnan S, Gupta SK, Chowdhury UK, Devagourou V, Talwar S, Hote MP, Rajashekar P, Sahu MK, Singh SP. Ivabradine Versus Amiodarone in the Management of Postoperative Junctional Ectopic Tachycardia: A Randomized, Open-Label, Noninferiority Study. JACC Clin Electrophysiol 2021; 7:1052-1060. [PMID: 33812837 DOI: 10.1016/j.jacep.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to compare the efficacy of ivabradine and amiodarone in the management of postoperative junctional ectopic tachycardia (JET) after cardiac surgery in children. BACKGROUND JET is a serious arrhythmia occurring in children after cardiac surgery and requires aggressive management. Amiodarone has been conventionally used in its treatment. Recent studies have reported the utility of ivabradine in this regard. METHODS In this open-label randomized controlled trial, 94 children (age ≤18 years) who developed postoperative JET were allocated to receive either amiodarone or ivabradine. The primary endpoint was restoration of normal sinus rhythm. RESULTS Sinus rhythm was achieved in 43 out of the 46 patients (93.5%) in the amiodarone group and 46 out of the 48 patients (95.8%) in the ivabradine group (mean difference of treatment effect: 2.3%; 95% confidence interval: -6.7% to 11.5%). The median (interquartile range) time taken to achieve sinus rhythm conversion was similar in both the groups: 21.5 (17-30.2) hours versus 22 (13.4-38.5) hours (p = 0.36)]. The time taken to rate control of JET was significantly less in the amiodarone group: median 7.0 (5.5-9.5) hours versus 8.0 (5.8-10.8) hours (p = 0.02)]. No drug-related adverse events were observed in the ivabradine group. CONCLUSIONS Oral ivabradine is not inferior to intravenous amiodarone in converting postoperative JET to sinus rhythm. There was no difference in time taken to sinus rhythm conversion between the groups, although the rate control was earlier in patients who received amiodarone. Monotherapy with ivabradine may be considered as an alternative to amiodarone in the management of postoperative JET. (Comparison of Two Drugs, Ivabradine and Amiodarone, in the Management of Junctional Ectopic Tachycardia, an Abnormality in Cardiac Rhythm in Patients Under 18 years Who Undergo Cardiac Surgery: CTRI/2018/08/015182).
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Affiliation(s)
- Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ujjwal K Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Milind P Hote
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Kumar Sahu
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarvesh Pal Singh
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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11
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Ahmed A, Prodhan P, Spray BJ, Bolin EH. Impact of Perioperative Tachydysrhythmias on Mortality and Length of Stay in Complete Repair of Tetralogy of Fallot: A Multicenter Retrospective Cohort Study from the Pediatric Health Information System. Cardiology 2021; 146:368-374. [PMID: 33735878 DOI: 10.1159/000512777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tachydysrhythmias (TDS) frequently occur after complete repair of tetralogy of Fallot (TOF). However, not much is known about the effect of TDS on morbidity and mortality after TOF repair. We sought to assess the associations between TDS and mortality and morbidity after repair of TOF using a multicentre database. MATERIALS AND METHODS We identified all children aged 0-5 years in the Pediatric Health Information System who underwent TOF repair between 2004 and 2015. Codes for TDS were used to identify cases. Outcome variables were inpatient mortality and total length of stay (LOS). Univariate and multiple logistic and linear regression analyses were used to identify the effects of multiple risk factors, including TDS, on mortality and LOS. RESULTS A total of 7,749 patients met inclusion criteria, of which 1,493 (19%) had codes for TDS. There was no association between TDS and inpatient mortality. However, TDS were associated with 1.1 days longer LOS and accounted for 2% of the variation observed in LOS. CONCLUSION After complete repair of TOF, TDS were not associated with mortality and appeared to have only a modest effect on LOS.
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Affiliation(s)
- Aziez Ahmed
- Children's Heart Center, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, Connecticut, USA,
| | - Parthak Prodhan
- Department of Pediatrics, Section of Pediatric Critical Care, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, USA
| | - Beverly J Spray
- Biostatistics Core, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Elijah H Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, USA
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12
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Kumar V, Kumar G, Tiwari N, Joshi S, Sharma V, Ramamurthy R. Ivabradine as an Adjunct for Refractory Junctional Ectopic Tachycardia Following Pediatric Cardiac Surgery: A Preliminary Study. World J Pediatr Congenit Heart Surg 2019; 10:709-714. [DOI: 10.1177/2150135119876600] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Junctional ectopic tachycardia (JET) is a relatively common narrow complex rhythm typically characterized by atrioventricular dissociation or retrograde atrial conduction in a 1:1 pattern. Junctional ectopic tachycardia can be a life-threatening disorder, causing severe hemodynamic compromise and increased morbidity and mortality. The treatment of refractory JET can be very difficult, even with multimodal therapeutic interventions. The purpose of this study was to assess the role of ivabradine in cases of JET refractory to amiodarone and esmolol. Methods: A total of 480 congenital heart surgeries were carried out at our center in 2017. Twenty (4.16%) patients had postoperative JET. Among these, five infants, aged 7 to 12 months (median: 8 months), had refractory JET. These patients (three tetralogy of Fallot, one ventricular septal defect, one complete atrioventricular septal defect) were treated with oral ivabradine in the dose range of 0.1 to 0.2 mg/kg/12 h as an adjunct to amiodarone. Results: All five patients achieved rate reduction and eventual conversion to sinus rhythm. Mean duration to achieve heart rate of <140 bpm after initiation of ivabradine therapy was 16.8 hours (±7.2 hours), while mean duration to achieve sinus rhythm was 31.6 hours (±13.6 hours). No patient had any recurrence of JET. No patient exhibited any hemodynamic derangement nor side effects attributable to oral ivabradine. Conclusion: Oral ivabradine has the potential to be used as an adjunct to amiodarone in the treatment of JET in infants after surgery for congenital heart disease.
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Affiliation(s)
- Vivek Kumar
- Army Hospital Research and Referral, New Delhi, India
- Department of Pediatric Cardiology, Army Hospital Research and Referral, New Delhi, India
| | - Gaurav Kumar
- Army Hospital Research and Referral, New Delhi, India
- Department of Cardiothoracic Surgery, Army Hospital Research and Referral, New Delhi, India
| | - Nikhil Tiwari
- Army Hospital Research and Referral, New Delhi, India
- Department of Cardiothoracic Surgery, Army Hospital Research and Referral, New Delhi, India
| | - Sajan Joshi
- Army Hospital Research and Referral, New Delhi, India
- Department of Cardiothoracic Anesthesiology, Army Hospital Research and Referral, New Delhi, India
| | - Vipul Sharma
- Army Hospital Research and Referral, New Delhi, India
- Department of Cardiothoracic Anesthesiology, Army Hospital Research and Referral, New Delhi, India
| | - Ravi Ramamurthy
- Army Hospital Research and Referral, New Delhi, India
- Department of Pediatric Cardiology, Army Hospital Research and Referral, New Delhi, India
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13
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Zhang ZP, Su X, Wang JY, Liu CW. Extracorporeal Membrane Oxygenation Support for Incessant Tachyarrhythmia-Induced Severe Cardiogenic Shock. Chin Med J (Engl) 2019; 131:2139-2140. [PMID: 30127234 PMCID: PMC6111685 DOI: 10.4103/0366-6999.239298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Zhi-Ping Zhang
- Department of Cardiology, Wuhan Asia Heart Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430022, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430022, China
| | - Jiang-You Wang
- Department of Cardiology, Wuhan Asia Heart Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430022, China
| | - Cheng-Wei Liu
- Department of Cardiology, Wuhan Asia Heart Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430022, China
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14
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Liu RZ, Li BT, Zhao GQ. Efficacy of different analgesic or sedative drug therapies in pediatric patients with congenital heart disease undergoing surgery: a network meta-analysis. World J Pediatr 2019; 15:235-245. [PMID: 31016566 DOI: 10.1007/s12519-019-00252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgery is an effective therapy for congenital heart disease (CHD) and the management after surgery poses challenges for the clinical workers. We performed this network meta-analysis to enhance the corresponding evidence with respect to the relative efficacy of different drug treatments applied after the CHD surgery. METHODS Embase and PubMed were systematically retrieved to identify all published controlled trials investigating the effectiveness of drugs for patients up to 25 August, 2018. Mean differences (MD), odds ratios and their 95% credible intervals (CrIs) were used to evaluate multi-aspect comparisons. Surface under cumulative ranking curve (SUCRA) was used to analyze the relative ranking of different treatments in each endpoint. RESULTS Compared to saline, all the drugs achieved better preference under the efficacy endpoints except fentanyl in JET. As for ventilator time, all drugs were more effective than saline while only the difference of dexmedetomidine was statistically obvious (MD = 6.92, 95% CrIs 1.77-12.54). Under the endpoint of ICU time, dexmedetomidine was superior to saline as well (MD = 1.26, 95% CrIs 0.11-2.45). When all the endpoints were taken into consideration and with the help of ranking probabilities and SUCRA values, fentanyl combined with dexmedetomidine was one of the recommended drugs due to its shorter time on ventilator and stay in hospital as well as lower mortality. CONCLUSIONS Overall, based on the comprehensive consideration of all the endpoints, fentanyl combined with dexmedetomidine was considered to be the best-recommended clinical interventions among all the methods.
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Affiliation(s)
- Rui-Zhu Liu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun 130000, China
| | - Bing-Tong Li
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, Changchun 130000, China
| | - Guo-Qing Zhao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun 130000, China.
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15
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Wise-Faberowski L, Asija R, McElhinney DB. Tetralogy of Fallot: Everything you wanted to know but were afraid to ask. Paediatr Anaesth 2019; 29:475-482. [PMID: 30592107 DOI: 10.1111/pan.13569] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/30/2018] [Accepted: 12/24/2018] [Indexed: 12/28/2022]
Abstract
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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Affiliation(s)
| | - Ritu Asija
- Department of Pediatrics, Stanford University, Palo Alto, California
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16
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Paluszek C, Brenner P, Pichlmaier M, Haas NA, Dalla-Pozza R, Hagl C, Hakami L. Risk Factors and Outcome of Post Fallot Repair Junctional Ectopic Tachycardia (JET). World J Pediatr Congenit Heart Surg 2019; 10:50-57. [PMID: 30799715 DOI: 10.1177/2150135118813124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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 = .010). Age-Patients with JET were of younger age ( P = .025) and had longer cardiopulmonary bypass ( P = .044) and aortic cross-clamping times ( P = .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.
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Affiliation(s)
- Corinna Paluszek
- 1 Department of Pediatric and Congenital Heart Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Paolo Brenner
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Maximilian Pichlmaier
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Nikolaus A Haas
- 3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Robert Dalla-Pozza
- 3 Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Christian Hagl
- 2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Lale Hakami
- 1 Department of Pediatric and Congenital Heart Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany.,2 Department of Cardiac Surgery, Medical Hospital of the University of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany
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17
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Li X, Zhang C, Dai D, Liu H, Ge S. Efficacy of dexmedetomidine in prevention of junctional ectopic tachycardia and acute kidney injury after pediatric cardiac surgery: A meta‐analysis. CONGENIT HEART DIS 2018; 13:799-807. [PMID: 30260073 DOI: 10.1111/chd.12674] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/14/2018] [Accepted: 08/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Xin Li
- Department of Cardiovascular Surgery The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Chengxin Zhang
- Department of Cardiovascular Surgery The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Di Dai
- Department of Cardiovascular Surgery The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Haiyuan Liu
- Department of Cardiovascular Surgery The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Shenglin Ge
- Department of Cardiovascular Surgery The First Affiliated Hospital of Anhui Medical University Hefei China
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18
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Ghimire LV, Chou FS. Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery patients: A systematic review and meta-analysis. Paediatr Anaesth 2018; 28:597-606. [PMID: 29882346 DOI: 10.1111/pan.13405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Junctional ectopic tachycardia is a serious tachyarrhythmic complication following pediatric cardiac surgery. It is difficult to manage and is associated with significant morbidity and mortality. Conventional nonpharmacological and pharmacological measures have shown limited effects. Dexmedetomidine is an α2 agonist which has recently been shown in multiple studies to be effective. AIMS The aim of this systematic review with meta-analysis was to evaluate the efficacy of prophylactic dexmedetomidine administration in the prevention of junctional ectopic tachycardia in pediatric patients following cardiac surgeries. METHODS We searched MEDLINE, EMBASE, Cochrane, Web of Science, and relevant references published in English before December 20, 2017 and performed meta-analysis on the selected studies, with one group receiving prophylactic perioperative dexmedetomidine administration and another group receiving placebo. The primary outcome was the incidence of junctional ectopic tachycardia, secondary outcomes included bradycardia, hypotension, intensive care unit stay, total hospital stay, inotropic scores, and total mechanical ventilation time. Odds ratio or mean difference with 95% confidence intervals were calculated using a random effect model. RESULTS Seven studies (5 prospective randomized studies and 2 retrospective case-controlled studies) with a total of 1616 patients were analyzed. The incidence of junctional ectopic tachycardia in the dexmedetomidine group was significantly reduced compared to placebo. Similarly, intensive care unit stay, inotropic scores, and total mechanical ventilation time were also significantly decreased in the dexmedetomidine group. No significant increases in adverse events were found. Mortality was low in both groups. CONCLUSION Prophylactic dexmedetomidine is effective in reducing the incidence of postoperative junctional ectopic tachycardia without significant increases in adverse events in pediatric patients undergoing surgery for congenital heart diseases.
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Affiliation(s)
- Laxmi V Ghimire
- Section of Pediatrics and Section of Cardiology, Department of Medicine, Lakes Region General Hospital, Laconia, NH, USA.,Department of Clinical Pediatrics, University of New England, Biddeford, ME, USA
| | - Fu-Sheng Chou
- Division of Neonatology, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
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19
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Ismail MF, Arafat AA, Hamouda TE, El Tantawy AE, Edrees A, Bogis A, Badawy N, Mahmoud AB, Elmahrouk AF, Jamjoom AA. Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years. J Cardiothorac Surg 2018; 13:60. [PMID: 29871684 PMCID: PMC5989382 DOI: 10.1186/s13019-018-0749-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/31/2018] [Indexed: 11/19/2022] Open
Abstract
Background Junctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age. Methods From 2003 to 2017, 609 patients had Tetralogy of Fallot repair, 322 were included in our study. We excluded patients above 2 years and patients with preoperative arrhythmia. 29.8% of the patients (n = 96) had postoperative JET. Results JET patients were younger and had higher preoperative heart rate. Independent predictors of JET were younger age, higher preoperative heart rate, cyanotic spells, non-use of B-blockers and low Mg and Ca (p = 0.011, 0.018, 0.024, 0.001, 0.004 and 0.001; respectively). JET didn’t affect the duration of mechanical ventilation nor hospital stay (p = 0.12 and 0.2 respectively) but prolonged the ICU stay (p = 0.011). JET resolved in 39.5% (n = 38) of patients responding to conventional measures. Amiodarone was used in 31.25% (n = 30) of patients and its use was associated with longer ICU stay (p = 0.017). Ventricular pacing was required in 4 patients (5.2%). Median duration of JET was 30.5 h and 5 patients had recurrent JET episode. Timing of JET onset didn’t affect ICU (p = 0.43) or hospital stay (p = 0.14) however, long duration of JET increased ICU and hospital stay (p = 0.02 and 0.009; respectively). Conclusion JET increases ICU stay after TOF repair. Preoperative B-blockers significantly reduced JET. Patients with preoperative risk factors could benefit from preoperative arrhythmia prophylaxis and aggressive management of postoperative electrolyte disturbance is essential.
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Affiliation(s)
- Mohamed Fouad Ismail
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O Box: 40047, Jeddah, 21499, Saudi Arabia.,Cardio-thoracic Surgery Department, Mansoura University, Mansoura, Egypt
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Tamer E Hamouda
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O Box: 40047, Jeddah, 21499, Saudi Arabia.,Cardio-thoracic Surgery Department, Benha University, Benha, Egypt
| | | | - Azzahra Edrees
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O Box: 40047, Jeddah, 21499, Saudi Arabia
| | - Abdulbadee Bogis
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O Box: 40047, Jeddah, 21499, Saudi Arabia
| | - Nashwa Badawy
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O Box: 40047, Jeddah, 21499, Saudi Arabia.,The Department of Pediatrics, Faculty of Medicine Cairo University, Cairo, Egypt
| | - Alaa B Mahmoud
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O Box: 40047, Jeddah, 21499, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Ahmed Farid Elmahrouk
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O Box: 40047, Jeddah, 21499, Saudi Arabia. .,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Ahmed A Jamjoom
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O Box: 40047, Jeddah, 21499, Saudi Arabia
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20
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Kusterer N, Morales G, Butt M, Darrat Y, Parrott K, Ogunbayo G, Bidwell K, Patel R, Delisle B, Czarapata M, Elayi CS. Junctional ectopic rhythm after AVNRT ablation: An underrecognized complication. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:182-193. [DOI: 10.1111/pace.13260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/21/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nathan Kusterer
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Gustavo Morales
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Muhammad Butt
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Yousef Darrat
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Kevin Parrott
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Gbolahan Ogunbayo
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Katrina Bidwell
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Ripa Patel
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Brian Delisle
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Melissa Czarapata
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Claude S. Elayi
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
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21
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Lim JKB, Mok YH, Loh YJ, Tan TH, Lee JH. The Impact of Time to Rate Control of Junctional Ectopic Tachycardia After Congenital Heart Surgery. World J Pediatr Congenit Heart Surg 2017; 8:685-690. [DOI: 10.1177/2150135117732544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Junctional ectopic tachycardia (JET) after congenital heart disease (CHD) surgery is often self-limiting but is associated with increased risk of morbidity and mortality. Contributing factors and impact of time to achieve rate control of JET are poorly described. Methods: From January 2010 to June 2015, a retrospective, single-center cohort study was performed of children who developed JET after CHD surgery . We classified the cohort into two groups: patients who achieved rate control of JET in ≤24 hours and in >24 hours. We examined factors associated with time to rate control and compared clinical outcomes (mortality, duration of mechanical ventilation, length of intensive care unit [ICU], and hospital stay) between the two groups. Results: Our cohort included 27 children, with a median age of 3 (interquartile range: 0.7-38] months. The most common CHD lesions were ventricular septal defect (n = 10, 37%), tetralogy of Fallot (n = 7, 25.9%), and transposition of the great arteries (n = 4, 14.8%). In all, 15 (55.6%) and 12 (44.4%) patients achieved rate control of JET in ≤24 hours and >24 hours, respectively. There was a difference in median mechanical ventilation time (97 [21-145) vs 311 [100-676] hours; P = .013) and ICU stay (5.0 [2.0-8.0] vs 15.5 [5.5-32.8] days, P = .023) between the patients who achieved faster rate control than those who didn’t. There was no difference in length of hospital stay and mortality between the groups. Conclusion: Our study demonstrated that time to achieve rate control of JET was associated with increased duration of mechanical ventilation and ICU stay.
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Affiliation(s)
| | - Yee Hui Mok
- Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS School of Medicine, Singapore
| | - Yee Jim Loh
- Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore, Singapore
- Cardiothoracic Surgery Service, KK Women’s and Children’s Hospital, Singapore
| | - Teng Hong Tan
- Duke-NUS School of Medicine, Singapore
- Cardiology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
| | - Jan Hau Lee
- Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS School of Medicine, Singapore
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Abstract
OBJECTIVES Here, we characterize the frequency, mechanisms, clinical impact, and potential treatment options for several arrhythmias commonly encountered in pediatric cardiac critical care. DATA SOURCE MEDLINE and PubMed. CONCLUSIONS Arrhythmias among children in the cardiac critical care setting are common and clinically important, associated independently with prolonged mechanical ventilation, critical care unit stay, and an increase in mortality. The precise characterization of an arrhythmia may provide clues as to an underlying mechanism as well as serve to guide treatment. Arrhythmia therapy, pharmacologic or otherwise, is directed toward addressing the underlying mechanism, and as such may be applicable to the treatment of more than one specific rhythm disturbance. Decisions concerning therapy must call into consideration an arrhythmia's underlying etiology, mechanism, and associated hemodynamic embarrassment, along with the potential for adverse effects of treatment.
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Wang L, Shang X, Qiu Q, Lu R, Xiao S, Li D, Yu J, Zhang C, Xia C, Zhou H, Zhang G. Late-Onset Postoperative Junctional Ectopic Tachycardia in Nonsurgical Procedures. Int Heart J 2016; 57:522-4. [PMID: 27385605 DOI: 10.1536/ihj.15-509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Postoperative junctional ectopic tachycardia (JET) is a narrow complex tachycardia and most frequently occurs during and after surgical repair of certain types of congenital heart defects. Postoperative junctional ectopic tachycardia may produce unfavorable hemodynamics that prolongs stays in the cardiac intensive care unit and hospital, prolongs time on a ventilator, and occasionally requires the use of extracorporeal membrane oxygenation (ECMO) as rescue therapy. The present report describes a rare case of late-onset postoperative junctional ectopic tachycardia, which occurred 13 days after the deployment of a perimembranous ventricular septal defect (PmVSD) occluder in a 17-year-old female teenager. To the best of our knowledge, late-onset postoperative junctional ectopic tachycardia has not previously been reported as a complication in nonsurgical procedures. In this case, the junctional ectopic tachycardia remained resistant to medicines and the haemodynamic imbalance caused a serious life-threatening situation in the patient. The occluder was removed by an emergent thoracotomy; then, the patient was successfully cured by being supported with extracorporeal membrane oxygenation. The findings suggest that during follow-up management, the physician should pay attention postoperatively to junctional ectopic tachycardia even after discharge from the hospital.
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Affiliation(s)
- Lijun Wang
- Cardiac Dynamics Laboratory, Wuhan Asia Heart Hospital
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Chenliu C, Sheng X, Dan P, Qu Y, Claydon VE, Lin E, Hove-Madsen L, Sanatani S, Tibbits GF. Ischemia-reperfusion destabilizes rhythmicity in immature atrioventricular pacemakers: A predisposing factor for postoperative arrhythmias in neonate rabbits. Heart Rhythm 2016; 13:2348-2355. [PMID: 27451283 DOI: 10.1016/j.hrthm.2016.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative arrhythmias such as junctional ectopic tachycardia and atrioventricular block are serious postoperative complications for children with congenital heart disease. We hypothesize that ischemia-reperfusion (I/R) related changes exacerbate these postoperative arrhythmias in the neonate heart and administration of postoperative inotropes is contributory. OBJECTIVE The purpose of this study was to study the effects of I/R and postischemic dopamine application on automaticity and rhythmicity in immature and mature pacemaker cells and whole heart preparations. METHODS Single pacemaker cells and whole heart models of postoperative arrhythmias were generated in a rabbit model encompassing 3 primary risk factors: age, I/R exposure, and dopamine application. Single cells were studied using current clamp and line scan confocal microscopy, whereas whole hearts were studied using optical mapping. RESULTS Four responses were observed in neonatal atrioventricular nodal cells (AVNCs): slowing of AVNC automaticity (from 62±10 to 36 ± 12 action potentials per minute, P<.05); induction of arrhythmicity or increased beat-to-beat variability (0.08 ± 0.04 to 3.83 ± 1.79, P<.05); altered automaticity (subthreshold electrical fluctuations); and disruption of calcium transients. In contrast, these responses were not observed in mature AVNCs or neonatal sinoatrial cells. In whole heart experiments, neonatal hearts experienced persistent postischemia arrhythmias of varying severity, whereas mature hearts exhibited no arrhythmias or relatively transient ones. CONCLUSION Neonatal pacemaker cells and whole hearts demonstrate a susceptibility to I/R insults resulting in alterations in automaticity, which may predispose neonates to postoperative arrhythmias such as junctional ectopic tachycardia and atrioventricular block.
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Affiliation(s)
- Cici Chenliu
- Cardiovascular Sciences, Child and Family Research Institute, Vancouver, BC, Canada; Molecular Cardiac Physiology Group, Simon Fraser University, Burnaby, BC, Canada
| | - Xiaoye Sheng
- Cardiovascular Sciences, Child and Family Research Institute, Vancouver, BC, Canada; Molecular Cardiac Physiology Group, Simon Fraser University, Burnaby, BC, Canada
| | - Pauline Dan
- Cardiovascular Sciences, Child and Family Research Institute, Vancouver, BC, Canada; Molecular Cardiac Physiology Group, Simon Fraser University, Burnaby, BC, Canada
| | - Yang Qu
- Cardiovascular Sciences, Child and Family Research Institute, Vancouver, BC, Canada; Molecular Cardiac Physiology Group, Simon Fraser University, Burnaby, BC, Canada
| | - Victoria E Claydon
- Molecular Cardiac Physiology Group, Simon Fraser University, Burnaby, BC, Canada
| | - Eric Lin
- Cardiovascular Sciences, Child and Family Research Institute, Vancouver, BC, Canada; Molecular Cardiac Physiology Group, Simon Fraser University, Burnaby, BC, Canada
| | - Leif Hove-Madsen
- Cardiovascular Research Centre CSIC-ICCC, Hospital de Sant Pau, Barcelona, Spain
| | - Shubhayan Sanatani
- Cardiovascular Sciences, Child and Family Research Institute, Vancouver, BC, Canada; Molecular Cardiac Physiology Group, Simon Fraser University, Burnaby, BC, Canada; Division of Pediatric Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Glen F Tibbits
- Cardiovascular Sciences, Child and Family Research Institute, Vancouver, BC, Canada; Molecular Cardiac Physiology Group, Simon Fraser University, Burnaby, BC, Canada.
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Philip Saul J, Kanter RJ, Abrams D, Asirvatham S, Bar-Cohen Y, Blaufox AD, Cannon B, Clark J, Dick M, Freter A, Kertesz NJ, Kirsh JA, Kugler J, LaPage M, McGowan FX, Miyake CY, Nathan A, Papagiannis J, Paul T, Pflaumer A, Skanes AC, Stevenson WG, Von Bergen N, Zimmerman F. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 2016; 13:e251-89. [DOI: 10.1016/j.hrthm.2016.02.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 11/15/2022]
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Circulation 2016; 133:e506-74. [DOI: 10.1161/cir.0000000000000311] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Hugh Calkins
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Jamie B. Conti
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Barbara J. Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - N.A. Mark Estes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Michael E. Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Stephen C. Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Julia H. Indik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Bruce D. Lindsay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Andrea M. Russo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Cynthia M. Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
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27
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. Circulation 2016; 133:e471-505. [DOI: 10.1161/cir.0000000000000310] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Hugh Calkins
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Jamie B. Conti
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Barbara J. Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - N.A. Mark Estes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Michael E. Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Stephen C. Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Julia H. Indik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Bruce D. Lindsay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Andrea M. Russo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Cynthia M. Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
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2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. J Am Coll Cardiol 2016; 67:1575-1623. [DOI: 10.1016/j.jacc.2015.09.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Amrousy DE, Elshehaby W, Feky WE, Elshmaa NS. Safety and Efficacy of Prophylactic Amiodarone in Preventing Early Junctional Ectopic Tachycardia (JET) in Children After Cardiac Surgery and Determination of Its Risk Factor. Pediatr Cardiol 2016; 37:734-9. [PMID: 26818850 DOI: 10.1007/s00246-016-1343-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/13/2016] [Indexed: 02/08/2023]
Abstract
Postoperative arrhythmia is a common complication after open heart surgery in children. JET is the most common and dangerous arrhythmia. We aimed to assess safety and efficacy of prophylactic amiodarone in preventing JET in children underwent cardiac surgery and to assess risk factors for JET among our patients. In total, 117 children who underwent cardiac surgery for CHD at Tanta University Hospital from October 2011 to April 2015 were divided in two groups; amiodarone group (65 patients) was given prophylactic amiodarone intraoperatively and placebo group (52 patients). Amiodarone is started as loading dose of 5 mg/kg IV in the operating room after induction of anesthesia and continued for 3 days as continuous infusion 10-15 μg/kg/min. Primary outcome and secondary outcomes of amiodarone administration were reported. We studied pre-, intra- and postoperative factors to determine risk factors for occurrence of JET among these children. Prophylactic amiodarone was found to significantly decrease incidence of postoperative JET from 28.9 % in placebo group to 9.2 % in amiodarone group, and symptomatic JET from 11.5 % in placebo group to 3.1 % in amiodarone group, and shorten postoperative intensive care unit and hospital stay without significant side effects. Risk factors for occurrence of JET were younger age, lower body weight, longer cardiopulmonary bypass, aortic cross-clamp time, hypokalemia, hypomagnesemia, acidosis and high dose of inotropes. JET was more associated with surgical repair of right ventricular outlet obstruction as in case of tetralogy of Fallot and pulmonary stenosis. Most of JET 15/21 (71.4 %) occurred in the first day postoperatively, and 6/21 occurred in the second day (28.6 %). Prophylactic amiodarone is safe and effective in preventing early JET in children after open heart surgery.
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Affiliation(s)
- Doaa El Amrousy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt.
| | - Walid Elshehaby
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | - Wael El Feky
- Cardiothoracic Surgery Department, Tanta University Hospital, Tanta, Egypt
| | - Nagat S Elshmaa
- Anesthesiology and Surgical ICU Department, Tanta University Hospital, Tanta, Egypt
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes III NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Heart Rhythm 2016; 13:e136-221. [DOI: 10.1016/j.hrthm.2015.09.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 01/27/2023]
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A Low-Cost Simulation Model for R-Wave Synchronized Atrial Pacing in Pediatric Patients with Postoperative Junctional Ectopic Tachycardia. PLoS One 2016; 11:e0150704. [PMID: 26943363 PMCID: PMC4778927 DOI: 10.1371/journal.pone.0150704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background Postoperative junctional ectopic tachycardia (JET) occurs frequently after pediatric cardiac surgery. R-wave synchronized atrial (AVT) pacing is used to re-establish atrioventricular synchrony. AVT pacing is complex, with technical pitfalls. We sought to establish and to test a low-cost simulation model suitable for training and analysis in AVT pacing. Methods A simulation model was developed based on a JET simulator, a simulation doll, a cardiac monitor, and a pacemaker. A computer program simulated electrocardiograms. Ten experienced pediatric cardiologists tested the model. Their performance was analyzed using a testing protocol with 10 working steps. Results Four testers found the simulation model realistic; 6 found it very realistic. Nine claimed that the trial had improved their skills. All testers considered the model useful in teaching AVT pacing. The simulation test identified 5 working steps in which major mistakes in performance test may impede safe and effective AVT pacing and thus permitted specific training. The components of the model (exclusive monitor and pacemaker) cost less than $50. Assembly and training-session expenses were trivial. Conclusions A realistic, low-cost simulation model of AVT pacing is described. The model is suitable for teaching and analyzing AVT pacing technique.
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Entenmann A, Michel M. Strategies for Temporary Cardiac Pacing in Pediatric Patients With Postoperative Junctional Ectopic Tachycardia. J Cardiothorac Vasc Anesth 2016; 30:217-21. [DOI: 10.1053/j.jvca.2015.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Indexed: 11/11/2022]
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Saygi M, Ergul Y, Tola HT, Ozyilmaz I, Ozturk E, Onan IS, Haydin S, Erek E, Yeniterzi M, Guzeltas A, Odemis E, Bakir I. Factors affecting perioperative mortality in tetralogy of Fallot. Pediatr Int 2015; 57:832-9. [PMID: 25807889 DOI: 10.1111/ped.12627] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/14/2015] [Accepted: 02/13/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND We evaluated the preoperative, operative and postoperative risk factors affecting early mortality in patients who underwent total correction of tetralogy of Fallot (TOF). METHODS One hundred and twenty-two TOF patients who underwent reparative surgery between January 2010 and November 2013 were enrolled in the study. RESULTS Mean patient age and weight was 2.3 ± 2.5 years and 11.3 ± 6.4 kg, respectively. Cardiac catheterization was performed in 101 patients (83%),and coronary anomalies were found in 11 patients. Mean McGoon index, pulmonary annulus z-score, main pulmonary artery z-score, left pulmonary artery z-score and right pulmonary artery z-score were 2.0 ± 0.4, -1.85 ± 1.54, -2.84 ± 2.06, 1.17 ± 1.73, and 0.74 ± 1.57, respectively. Total reparative surgery with a transannular patch was performed in 97 patients (79.6%); the rest underwent valve-sparing surgery. Median duration of postoperative mechanical ventilation, intensive care and hospital stay were 19 h, 3 days and 9 days, respectively. Extracorporeal membrane oxygenation (ECMO) was required in 10 patients in the postoperative early period. Arrhythmias occurring in the early postoperative period were junctional ectopic tachycardia (n = 13), complete atrioventricular block(n = 10; permanent epicardial pacemaker implanted in four) and ventricular tachycardia (n = 4). Nine patients died in the early postoperative period (7.3%). Parameters found to be associated with increased mortality were low preoperative oxygen saturation; high right ventricular/aortic pressure ratio immediately after surgery; presence of coronary anomaly; requirement of postoperative ECMO; and pacemaker (P = 0.02, P = 0.04, P = 0.01, P = 0.0001, P = 0.03, respectively). CONCLUSIONS Poor preoperative oxygenation, presence of coronary anomaly, complete AV block in the early postoperative period, high RV pressure and requirement of ECMO appear to be the most significant factors that affect early mortality in the surgical treatment of TOF. Appropriate preoperative assessment, correct surgical strategies and attentive intensive care monitoring are required in order to reduce mortality.
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Affiliation(s)
- Murat Saygi
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Hasan Tahsin Tola
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Isa Ozyilmaz
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ismihan Selen Onan
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Yeniterzi
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ender Odemis
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2015; 13:e92-135. [PMID: 26409097 DOI: 10.1016/j.hrthm.2015.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 10/23/2022]
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2015; 67:e27-e115. [PMID: 26409259 DOI: 10.1016/j.jacc.2015.08.856] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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He D, Sznycer-Taub N, Cheng Y, McCarter R, Jonas RA, Hanumanthaiah S, Moak JP. Magnesium Lowers the Incidence of Postoperative Junctional Ectopic Tachycardia in Congenital Heart Surgical Patients: Is There a Relationship to Surgical Procedure Complexity? Pediatr Cardiol 2015; 36:1179-85. [PMID: 25762470 PMCID: PMC4561858 DOI: 10.1007/s00246-015-1141-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
Magnesium sulfate was given to pediatric cardiac surgical patients during cardiopulmonary bypass period in an attempt to reduce the occurrence of postoperative junctional ectopic tachycardia (PO JET). We reviewed our data to evaluate the effect of magnesium on the occurrence of JET and assess a possible relationship between PO JET and procedure complexity. A total of 1088 congenital heart surgeries (CHS), performed from 2005 to 2010, were reviewed. A total of 750 cases did not receive magnesium, and 338 cases received magnesium (25 mg/kg). All procedures were classified according to Aristotle score from 1 to 4. Overall, there was a statistically significant decrease in PO JET occurrence between the two groups regardless of the Aristotle score, 15.3 % (115/750) in non-magnesium group versus 7.1 % (24/338) in magnesium group, P < 0.001. In the absence of magnesium, the risk of JET increased with increasing Aristotle score, P = 0.01. Following magnesium administration and controlling for body weight, surgical and aortic cross-clamp times in the analyses, reduction in adjusted risk of JET was significantly greater with increasing Aristotle level of complexity (JET in non-magnesium vs. magnesium group, Aristotle level 1: 9.8 vs. 14.3 %, level 4: 11.5 vs. 3.2 %; odds ratio 0.54, 95 % CI 0.31-0.94, P = 0.028). Our data confirmed that intra-operative usage of magnesium reduced the occurrence of PO JET in a larger number and more diverse group of CHS patients than has previously been reported. Further, our data suggest that magnesium's effect on PO JET occurrence seemed more effective in CHS with higher levels of Aristotle complexity.
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Affiliation(s)
- Dingchao He
- Division of Cardiovascular Surgery, Children’s National Medical Center, Washington, DC, USA
| | | | - Yao Cheng
- Division of Biostatistics and Study Methodology, Children’s National Medical Center, Washington, DC, USA
| | - Robert McCarter
- Division of Biostatistics and Study Methodology, Children’s National Medical Center, Washington, DC, USA
| | - Richard A. Jonas
- Division of Cardiovascular Surgery, Children’s National Medical Center, Washington, DC, USA
| | - Sridhar Hanumanthaiah
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010, USA
| | - Jeffrey P. Moak
- Division of Cardiology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010, USA
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Intra-operative arrhythmia predicts post-operative arrhythmia and the need for temporary pacing wires. Cardiol Young 2015; 25:454-8. [PMID: 24495310 DOI: 10.1017/s1047951114000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Protocols for the placement of temporary pacing wires vary among institutions. Our current protocol is to selectively place temporary pacing wires in those patients who develop haemodynamically significant intra-operative arrhythmia. We wished to identify how effective our current protocol is at identifying who will develop post-operative arrhythmia and need temporary pacing wires. METHODS The charts of 880 patients over 8 years who underwent cardiopulmonary bypass were reviewed to find patients who developed intra-operative arrhythmia, had temporary pacing wires placed, and whether or not they developed post-operative arrhythmia and required utilisation of the pacing wires. RESULTS A total of 87 (9.9%) out of 880 patients who required cardiopulmonary bypass over 8 years had intra-operative arrhythmia and had temporary pacing wires placed. Of these, 59 (67.8%) had post-operative arrhythmia and utilised the pacing wires, whereas 28 (32.2%) did not have post-operative arrhythmia or utilise the pacing wires. In all, seven patients who did not have intra-operative arrhythmia or temporary pacing wires placed developed post-operative arrhythmia. CONCLUSION Intra-operative arrhythmia is predictive of post-operative arrhythmia (70.2%) and our protocol is a sensitive means of identifying those who will develop post-operative arrhythmia (89.3%).
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Ventricular fibrillation following synchronized cardioversion in junctional ectopic tachycardia: a pediatric case report. AACN Adv Crit Care 2014; 25:20-2. [PMID: 24441449 DOI: 10.1097/nci.0000000000000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rajput RS, Das S, Makhija N, Airan B. Efficacy of dexmedetomidine for the control of junctional ectopic tachycardia after repair of tetralogy of Fallot. Ann Pediatr Cardiol 2014; 7:167-72. [PMID: 25298690 PMCID: PMC4189232 DOI: 10.4103/0974-2069.140826] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Junctional ectopic tachycardia occurs frequently after congenital cardiac surgery and can be a cause of increased morbidity and mortality. Dexmedetomidine (DEX) is an α2 adrenoreceptor agonist, has properties of controlling tachyarrhythmia by regulating the sympatho-adrenal system. Objective: To evaluate the efficacy of DEX for control of junctional ectopic tachycardia after repair of Tetralogy of Fallot (TOF). Materials and Methods: Two hundred and twenty pediatric cardiac patients with TOFs were enrolled in a prospective randomized control study. Patients underwent correction surgery. They were divided into two groups, i.e., Group 1 (DEX) and Group 2 (control). Heart rate, rhythm, mean arterial pressure (MAP) were recorded after the anesthetic induction (T1), after termination of bypass (T2), after 04 hours (T3), and 08 hours after transferring the patient to intensive care unit (ICU; T4). Results: Heart rate was comparable between two groups before starting the drug but statistically significant after bypass until 08 hours after transferring the patient to ICU. Junctional ectopic tachycardia occurred more in Group-2 (20%) as compared to Group-1 (9.09%; P = 0.022). Junctional ectopic tachycardia occurs early in Group-2 (0.14 ± 0.527 hours) as compared to Group 1 (0.31 ± 1.29 hours; P = 0.042). The duration of junctional ectopic tachycardia was more prolonged in Group-2 (1.63 ± 3.64 hours) as compared to Group-1 (0.382 ± 1.60 hours; P = 0.012). The time to withdraw from mechanical ventilation and ICU stay of Group 1 patient was less than of Group 2 patients (P = <0.001). Conclusion: DEX had a therapeutic role in the prevention of junctional ectopic tachycardia in patients undergoing repair for TOF.
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Affiliation(s)
- Randhir S Rajput
- Department of Cardiac Anesthesia, All India Institute Medical Sciences, New Delhi, India
| | - Sambhunath Das
- Department of Cardiac Anesthesia, All India Institute Medical Sciences, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anesthesia, All India Institute Medical Sciences, New Delhi, India
| | - Balram Airan
- Department of Cardiothoracic and Vascular Surgery, All India Institute Medical Sciences, New Delhi, India
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Egbe AC, Nguyen K, Mittnacht AJ, Joashi U. Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:211-9. [PMID: 25207217 PMCID: PMC4157470 DOI: 10.5090/kjtcs.2014.47.3.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/27/2013] [Accepted: 12/31/2013] [Indexed: 11/25/2022]
Abstract
Background Our objectives were to review our institutional early and midterm experience with primary tetralogy of Fallot (TOF) repair, and identify predictors of intensive care unit (ICU) morbidity. Methods We analyzed perioperative and midterm follow-up data for all cases of primary TOF repair from 2001 to 2012. The primary endpoint was early mortality and morbidity, and the secondary endpoint was survival and functional status at follow-up. Results Ninety-seven patients underwent primary repair. The median age was 4.9 months (range, 1 to 9 months), and the median weight was 5.3 kg (range, 3.1 to 9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median length of ICU stay was 6 days (range, 2 to 21 days), and the median duration of mechanical ventilation was 19 hours (range, 0 to 136 hours). By multiple regression analysis, age and weight were independent predictors of the length of ICU stay, while the surgical era was an independent predictor of the duration of mechanical ventilation. At the 8-year follow-up, freedom from death and re-intervention was 97% and 90%, respectively. Conclusion Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.
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Affiliation(s)
- Alexander C Egbe
- Division of Pediatric Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Khanh Nguyen
- Division of Pediatric Cardiology, Mount Sinai Hospital, New York, NY, USA
| | | | - Umesh Joashi
- Division of Pediatric Cardiology, Mount Sinai Hospital, New York, NY, USA
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Egbe AC, Mittnacht AJ, Nguyen K, Joashi U. Risk factors for morbidity in infants undergoing tetralogy of fallot repair. Ann Pediatr Cardiol 2014; 7:13-8. [PMID: 24701079 PMCID: PMC3959054 DOI: 10.4103/0974-2069.126539] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Primary repair of tetralogy of Fallot (TOF) has low surgical mortality, but some patients still experience significant postoperative morbidity. Aim: To review our institutional experience with primary TOF repair, and identify predictors of intensive care unit (ICU) morbidity. Settings and Design: Medium-sized pediatric cardiology program. Retrospective study. Subjects and Methods: We retrospectively reviewed all the patients with TOF and pulmonic stenosis who underwent primary repair in infancy at our institution from January 2001 to December 2012. Preoperative, operative, and postoperative demographic and morphologic data were analyzed. ICU morbidity was defined as prolonged ICU stay (≥7 days), and/or prolonged duration of mechanical ventilation (≥48 h). Statistical Analysis Used: Multiple logistic regression analysis. Results: Ninety-seven patients underwent primary surgical repair during the study period. The median age was 4.9 months (1-9 months) and the median weight was 5.3 kg (3.1-9.8 kg). There was no early surgical mortality. Incidence of junctional ectopic tachycardia (JET) and persistent complete heart block was 2 and 1%, respectively. The median length of ICU stay was 6 days (2-21 days) and median duration of mechanical ventilation was 19 h (0-136 h). By multiple regression analysis, age and weight were independent predictors of length of ICU stay, while surgical era was an independent predictor of duration of mechanical ventilation. Conclusion: Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.
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Affiliation(s)
- Alexander C Egbe
- Division of Pediatric Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY
| | - Alexander J Mittnacht
- Division of Pediatric Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY
| | - Khanh Nguyen
- Division of Pediatric Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY
| | - Umesh Joashi
- Division of Pediatric Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY
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Abdelaziz O, Deraz S. Anticipation and management of junctional ectopic tachycardia in postoperative cardiac surgery: Single center experience with high incidence. Ann Pediatr Cardiol 2014; 7:19-24. [PMID: 24701080 PMCID: PMC3959055 DOI: 10.4103/0974-2069.126543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Junctional ectopic tachycardia (JET) often occurs in the early postoperative period following surgery for congenital heart diseases and may lead to hemodynamic compromise. Its exact etiology is unknown, however, longer cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, catecholamines, and hypomagnesemia are known risk factors. JET is associated with increased postoperative morbidity and mortality. MATERIALS AND METHODS A prospective cohort study of 194 consecutive children who underwent open heart surgery on CPB over 1 year period, patients was divided into three groups; JET, non-JET arrhythmia, and no arrhythmia groups. Information on patient's demographics (sex, age, and body weight), type of surgical interventions, duration of CPB and ACC, the use of inotropic support, duration of intensive care unit (ICU) stay, and response to different therapeutic methods were collected. RESULTS JET was documented in 53 patients (27%) most commonly following tetralogy of Fallot (TOF) repair and was associated with longer CPB and ACC times (118 and 77 min, respectively) as compared to non-JET arrhythmia (93.9 and 55.3 min, respectively) and no arrhythmia groups (94.9 and 54.8 min, respectively). Patients with JET required more inotropic support and longer ICU stay as compared to other groups. Amiodarone was safe and effective in treatment of JET. Atrial electrocardiogram (ECG) and Lewis lead ECG were helpful tools in JET diagnosis. The mortality was 11.5% in JET patients. CONCLUSIONS Incidence of JET was 27% possibly due to the large number of Fallot repair and Senning operation. Longer CPB and ACC times are risk factors for JET.
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Affiliation(s)
- Osama Abdelaziz
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Salem Deraz
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
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Niu MC, Morris SA, Morales DLS, Fraser CD, Kim JJ. Low incidence of arrhythmias in the right ventricular infundibulum sparing approach to tetralogy of Fallot repair. Pediatr Cardiol 2014; 35:261-9. [PMID: 23921493 DOI: 10.1007/s00246-013-0767-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 07/19/2013] [Indexed: 11/29/2022]
Abstract
To improve outcomes, including arrhythmia incidence, for patients with tetralogy of Fallot (TOF), the authors' institution adopted an approach that minimizes or avoids transmural incision of the right ventricular outflow tract. When pulmonary blood flow is insufficient during the neonatal period, placement of an aortopulmonary artery shunt is preferred, followed by complete repair later in infancy. This study reviewed the perioperative and mid-term arrhythmia outcomes at the authors' institution using this approach. Patients who underwent TOF repair from 1995 to 2008 were included in the study. Patient demographics and surgical history were collected. The primary end points of the study included documented perioperative arrhythmias and arrhythmias at the 10-year follow-up assessment. Of the 298 patients who underwent TOF repair, 50 (17 %) had undergone prior placement of a systemic-to-pulmonary artery shunt. The median age at repair was 9.7 months (interquartile range, 6.3-16.2 months). Clinically significant perioperative arrhythmias were found in 12 patients (4 %) including 6 junctional tachycardias, 4 atrial tachycardias, and 1 temporary complete heart block. No patients were receiving antiarrhythmic medications more than 24 months after surgery. Of the 298 patients, 86 (29 %) had a follow-up period of 10 years or longer (median, 12.2 years). No patients experienced new arrhythmias, received antiarrhythmic therapy, experienced post-discharge ventricular tachycardia, had atrioventricular block, or required a pacemaker or defibrillator. The right ventricular infundibulum sparing approach is associated with an extremely low incidence of perioperative and midterm arrhythmias. The perioperative and mid-term outcomes compare favorably with existing data from programs favoring neonatal repair. Long-term follow-up evaluation is essential to determine whether this strategy can effectively alter late pathophysiology and minimize late-term arrhythmias and associated mortality.
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Affiliation(s)
- Mary C Niu
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA,
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Kelly SP, Shoun P, Mikol J, Steelman R. Ventricular Fibrillation Following Synchronized Cardioversion in Junctional Ectopic Tachycardia: A Pediatric Case Report. AACN Adv Crit Care 2014. [DOI: 10.4037/nci.0000000000000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Serena Phromsivarak Kelly
- Serena Phromsivarak Kelly is Nurse Practitioner, Pediatric Intensive Care Unit, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon
| | - Patricia Shoun
- Patricia Shoun is Staff Nurse, Pediatric Intensive Care Unit, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon
| | - Joanne Mikol
- Joanne Mikol is Staff Nurse, Pediatric Intensive Care Unit, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon
| | - Robert Steelman
- Robert Steelman is Associate Professor, Pediatric Critical Care Medicine/Anesthesiology, Oregon Health & Science University, 700 SW Campus Dr, Portland, OR 97239
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Egbe AC, Uppu SC, Mittnacht AJC, Joashi U, Ho D, Nguyen K, Srivastava S. Primary tetralogy of Fallot repair: Predictors of intensive care unit morbidity. Asian Cardiovasc Thorac Ann 2013; 22:794-9. [DOI: 10.1177/0218492313513773] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Primary repair of tetralogy of Fallot has low surgical mortality, but some patients still experience significant postoperative morbidity. Our objectives were to review our institutional experience with primary tetralogy of Fallot repair, and identify predictors of intensive care unit morbidity. Methods We reviewed all patients with tetralogy of Fallot who underwent primary repair in infancy from 2001 to 2012. Preoperative, operative, and postoperative demographic and morphologic data were analyzed. Intensive care unit morbidity was defined as prolonged intensive care unit stay (≥7 days) and/or prolonged duration of mechanical ventilation (≥48 h). Results 97 patients who underwent primary surgical repair during the study period were included in the study. The median age was 4.9 months (range 1–9 months) and the median weight was 5.3 kg (range 3.1–9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median intensive care unit stay was 6 days (range 2–21 days) and the median duration of mechanical ventilation was 19 h (range 0–136 h). Age and weight were independent predictors of intensive care unit stay, while surgical era predicted the duration of mechanical ventilation. Conclusion Primary tetralogy of Fallot repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery were significant predictors of morbidity.
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Affiliation(s)
- Alexander C Egbe
- Division of Pediatric Cardiology, Mount Sinai Hospital, New York, USA
| | - Santosh C Uppu
- Division of Pediatric Cardiology, Mount Sinai Hospital, New York, USA
| | | | - Umesh Joashi
- Division of Pediatric Cardiology, Mount Sinai Hospital, New York, USA
| | - Deborah Ho
- Division of Pediatric Cardiology, Mount Sinai Hospital, New York, USA
| | - Khanh Nguyen
- Division of Pediatric Cardiology, Mount Sinai Hospital, New York, USA
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R-wave synchronised atrial pacing in post-operative junctional ectopic tachycardia using a transoesophageal pacemaker. Cardiol Young 2013; 23:763-5. [PMID: 23113931 DOI: 10.1017/s1047951112001692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report the first case of R-wave synchronised atrial pacing using a transoesophageal pacemaker. A 3-month-old baby developed a junctional ectopic tachycardia after surgical closure of a ventricular septal defect. R-wave synchronised atrial pacing with an external pacemaker was not possible owing to dislocation of the atrial epimyocardial pacing wires. Therefore, a temporary oesophageal pacemaker was connected in series to the external pacemaker to allow transoesophageal atrial pacing triggered by the preceding ventricular actions.
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47
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Sanil Y, Aggarwal S. Vasoactive-inotropic score after pediatric heart transplant: a marker of adverse outcome. Pediatr Transplant 2013; 17:567-72. [PMID: 23773439 DOI: 10.1111/petr.12112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 01/08/2023]
Abstract
VIS, a quantitative index of pressor support, has been shown to be a predictor of morbidity and mortality in infants younger than six months who underwent CPB. Data on its prognostic utility following pediatric OHT are lacking. This study compared clinical outcomes in children with differential VIS after pediatric OHT. A retrospective cohort study of 51 consecutive heart transplants from 2004 to 2011 was performed at a pediatric tertiary care facility. Peak VIS was computed within initial 24 and 48 h after OHT and was weighted for peak dose and administration of any or all of six pressors. Patients with peak VIS ≥ 15 constituted high VIS group. Children who persistently required a higher magnitude of pressor support for the first 48 h after OHT, as reflected by high peak VIS, had significantly longer ICU stay (30.2 vs. 15.9 days, p = 0.01), pressor (11.4 vs. 6.8 days, p = 0.02) and ventilatory durations (12.4 vs. 5.9 days, p = 0.05), and higher rates of short-term morbidities. Patients with longer CPB (213 vs. 153 min, p = 0.005) time have higher peak VIS. High peak VIS at 48 h is an effective, yet simple clinical marker for adverse outcomes in pediatric OHT recipients.
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Affiliation(s)
- Yamuna Sanil
- Division of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.
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Siehr SL, Hanley FL, Reddy VM, Miyake CY, Dubin AM. Incidence and risk factors of complete atrioventricular block after operative ventricular septal defect repair. CONGENIT HEART DIS 2013; 9:211-5. [PMID: 23764088 DOI: 10.1111/chd.12110] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complete atrioventricular block (AVB) is a recognized complication of ventricular septal defect (VSD) repair. The objective of this study was to examine incidence and risk factors. METHODS This is a single-center, retrospective study. All pediatric patients (age <18 years) who underwent VSD repair between November 2001 and August 2009 with concordant atrioventricular and ventriculoarterial connections were included. Patients were classified as having no AVB or transient AVB, and outcomes of early pacemaker placement (before hospital discharge) or late pacemaker placement (after hospital discharge) were recorded. RESULTS Eight hundred twenty-eight patients (48.6% female) underwent VSD repair during the study period. Mean age at repair was 14 ± 29.4 months. A total of 64 patients (7.7%) developed surgical AVB. Among those patients who developed AVB, 48 (75%) had transient AVB. Sixteen patients (1.9%) required a pacemaker, 14 early (88%) and 2 late (12%). Patients <4 kg (4.2% vs. 1%, P ≤ .01) and those with inlet VSDs (11.6% vs. 1.4%, P ≤ .01) were more likely to develop surgical AVB. Surgical AVB was not influenced by the presence of chromosomal abnormalities or other congenital heart disease. CONCLUSION The overall incidence of surgical AVB is consistent with previous reports. Weight <4 kg and presence of an inlet VSD were significant risk factors.
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Affiliation(s)
- Stephanie L Siehr
- Department of Pediatrics, Stanford University, Palo Alto, Calif, USA
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MOAK JEFFREYP, ARIAS PATRICIO, KALTMAN JONATHANR, CHENG YAO, MCCARTER ROBERT, HANUMANTHAIAH SRIDHAR, MARTIN GERARDR, JONAS RICHARDA. Postoperative Junctional Ectopic Tachycardia: Risk Factors for Occurrence in the Modern Surgical Era. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1156-68. [DOI: 10.1111/pace.12163] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 01/29/2013] [Accepted: 03/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
- JEFFREY P. MOAK
- Division of Cardiology; Children's National Medical Center; Washington DC
| | - PATRICIO ARIAS
- Division of Cardiology; Children's National Medical Center; Washington DC
| | | | - YAO CHENG
- Department of Biostatistics and Informatics; Children's National Medical Center; Washington DC
| | - ROBERT MCCARTER
- Department of Biostatistics and Informatics; Children's National Medical Center; Washington DC
| | | | - GERARD R. MARTIN
- Division of Cardiology; Children's National Medical Center; Washington DC
| | - RICHARD A. JONAS
- Division of Cardiovascular Surgery; Children's National Medical Center; Washington DC
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50
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Makhoul M, Oster M, Fischbach P, Das S, Deshpande S. Junctional ectopic tachycardia after congenital heart surgery in the current surgical era. Pediatr Cardiol 2013; 34:370-4. [PMID: 22987106 DOI: 10.1007/s00246-012-0465-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/17/2012] [Indexed: 11/25/2022]
Abstract
To determine the incidence of postoperative junctional ectopic tachycardia (JET) in a modern cohort of pediatric patients, evaluate possible risk factors for JET, and examine the effects of JET on postoperative morbidity and mortality. JET is common after congenital heart surgery. JET-related mortality has been a rare event at our center, which is different from previous reports. We reviewed records for pediatric patients who had postoperative arrhythmias between January 2006 and June 2010 at a large tertiary-care children's hospital. We performed a matched case-control study to identify risk factors for JET and a matched-cohort study to compare outcomes between patients and controls. Whenever possible, each JET case was randomly matched to two controls on the basis of lesion, repair, and surgical period. We identified 54 patients with JET (incidence = 1.4 %). After multivariate logistic regression analysis, low operative weight, cardiopulmonary bypass (CPB) duration >100 min, and immediate postoperative serum lactic acid level >20 mg/dl were associated with increased odds of developing JET. Patients with JET had longer mechanical ventilation time, cardiac intensive care unit (CICU) stay, and hospital stay. There was only one death in JET group (1.8 %) with no significant difference compared with the control group. JET remains a relatively common postoperative arrhythmia, but it is less frequent than previously reported. JET occurs more commonly in smaller patients with longer CPB runs and significant postoperative lactic acidosis levels. Mortality associated with JET is lower than historically reported, but morbidity remains high.
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Affiliation(s)
- Majd Makhoul
- Pediatric Cardiology Division, Children's Healthcare of Atlanta at Egleston, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, USA.
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