Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2years

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 2years of age. Methods: From 2003 to 2017, 609 patients had Tetralogy of Fallot repair, 322 were included in our study. We excluded patients above 2years 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 30.5h 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.