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Roman Gebauer - One of the best experts on this subject based on the ideXlab platform.
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Management of postoperative Junctional Ectopic Tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland
European Journal of Pediatrics, 2017Co-Authors: Andreas Entenmann, Miriam Michel, Friedemann Egender, Ulrike Herberg, Nikolaus Haas, Matthias Kumpf, Matthias Gass, Roman GebauerAbstract:Postoperative Junctional Ectopic Tachycardia (JET) is a frequent complication after pediatric cardiac surgery. Current recommendations on how and when to treat JET are inconsistent. We evaluated the management strategies of postoperative JET in German-speaking countries. We sent an online survey to 30 centers of pediatric cardiology that perform surgery for congenital heart defects in Germany (24), Austria (4), and Switzerland (2). The survey asked 18 questions about how and in what treatment sequence postoperative JET was managed. All 30 centers completed the survey (100% return rate). There was general agreement that the management of JET is based on administration of antiarrhythmic drugs, body surface cooling, and temporary pacing. Many centers presented treatment algorithms based on published literature, all centers named amiodarone as the first drug of choice. Significant disagreement was found concerning the timing and sequential order of additional therapeutic measures and particularly about the dosing of amiodarone and the role of R-wave synchronized atrial pacing. Conclusion : This survey reveals that from center to center, the treatment of postoperative JET may vary substantially. Future work should focus on those treatment modalities where a high rate of variation is found. Such studies may be of value to achieve commonly adopted treatment recommendations. What is known: • Treatment of postoperative Junctional Ectopic Tachycardia is predominantly based on administration of antiarrhythmic drugs, therapeutic cooling, and temporary pacing. • Amiodarone is the antiarrhythmic drug of choice in this context. What is new: • Dosing and duration of administration of amiodarone differ relevantly from center to center. • The sequential order of drug administration, therapeutic cooling, and pacing is not consistent.
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Management of postoperative Junctional Ectopic Tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland.
European journal of pediatrics, 2017Co-Authors: Andreas Entenmann, Nikolaus A. Haas, Miriam Michel, Friedemann Egender, Ulrike Herberg, Matthias Kumpf, Matthias Gass, Roman GebauerAbstract:Postoperative Junctional Ectopic Tachycardia (JET) is a frequent complication after pediatric cardiac surgery. Current recommendations on how and when to treat JET are inconsistent. We evaluated the management strategies of postoperative JET in German-speaking countries. We sent an online survey to 30 centers of pediatric cardiology that perform surgery for congenital heart defects in Germany (24), Austria (4), and Switzerland (2). The survey asked 18 questions about how and in what treatment sequence postoperative JET was managed. All 30 centers completed the survey (100% return rate). There was general agreement that the management of JET is based on administration of antiarrhythmic drugs, body surface cooling, and temporary pacing. Many centers presented treatment algorithms based on published literature, all centers named amiodarone as the first drug of choice. Significant disagreement was found concerning the timing and sequential order of additional therapeutic measures and particularly about the dosing of amiodarone and the role of R-wave synchronized atrial pacing.
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association of temporary complete av block and Junctional Ectopic Tachycardia after surgery for congenital heart disease
Annals of Pediatric Cardiology, 2015Co-Authors: Christian Paech, Ingo Dahnert, Martin Kostelka, Meinhardt Mende, Roman GebauerAbstract:Aim: Junctional Ectopic Tachycardia (JET) is a postoperative complication with a mortality rate of up to 14% after surgery for congenital heart disease. This study evaluated the risk factors of JET and explored the association of postoperative temporary third degree atrioventricular (AV) block and the occurrence of JET. Materials and Methods: Data were collected retrospectively from 1158 patients who underwent surgery for congenital heart disease. Results: The overall incidence of JET was 2.8%. Temporary third degree AV block occurred in 1.6% of cases. Permanent third degree AV block requiring pacemaker implantation occurred in 1% of cases. In all, 56% of patients with JET had temporary AV block (P Conclusions: A correlation between temporary third degree AV block and postoperative JET could be observed. The risk factors identified for JET include younger age groups at the time of surgery, longer aortic cross clamping time and surgical procedures in proximity to the AV node.
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Association of temporary complete AV block and Junctional Ectopic Tachycardia after surgery for congenital heart disease
Wolters Kluwer Medknow Publications, 2015Co-Authors: Christian Paech, Ingo Dahnert, Martin Kostelka, Meinhardt Mende, Roman GebauerAbstract:Aim: Junctional Ectopic Tachycardia (JET) is a postoperative complication with a mortality rate of up to 14% after surgery for congenital heart disease. This study evaluated the risk factors of JET and explored the association of postoperative temporary third degree atrioventricular (AV) block and the occurrence of JET. Materials and Methods: Data were collected retrospectively from 1158 patients who underwent surgery for congenital heart disease. Results: The overall incidence of JET was 2.8%. Temporary third degree AV block occurred in 1.6% of cases. Permanent third degree AV block requiring pacemaker implantation occurred in 1% of cases. In all, 56% of patients with JET had temporary AV block (P < 0.001), whereas no case of postoperative JET was reported in patients with permanent AV block (P = 0.56). temporary third degree AV block did not suffer from JET. Conclusions: A correlation between temporary third degree AV block and postoperative JET could be observed. The risk factors identified for JET include younger age groups at the time of surgery, longer aortic cross clamping time and surgical procedures in proximity to the AV node
Narayanswami Sreeram - One of the best experts on this subject based on the ideXlab platform.
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Radiofrequency catheter ablation of Junctional Ectopic Tachycardia with preservation of atrioventricular conduction.
Pacing and clinical electrophysiology : PACE, 2003Co-Authors: Timothy A. Simmers, Narayanswami Sreeram, Fred H.m. Wittkampf, Richard DerksenAbstract:Junctional Ectopic Tachycardia is a relatively rare disorder, frequently refractory to drug therapy, and with a poor prognosis in childhood. This report describes a successful radiofrequency catheter ablation of the focus of this arrhythmia in a 9-year-old girl with preservation of normal atrioventricular conduction, using precise catheter navigation with the LocaLisa system and carefully titrated RF delivery.
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Polymorphic ventricular Tachycardia after use of intravenous amiodarone for postoperative Junctional Ectopic Tachycardia.
International Journal of Cardiology, 2000Co-Authors: S.-c Yap, T Hoomtje, Narayanswami SreeramAbstract:Abstract Postoperative Junctional Ectopic Tachycardia (JET) is a life threatening arrhythmia which responds poorly to pharmacologic therapy. Intravenous amiodarone has been described to be safe and effective in a small series of patients with JET. We present three boys with congenital cardiac defects who developed polymorphic ventricular Tachycardia after the use of intravenous amiodarone for postoperative JET. Two patients did not survive the complication.
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Junctional Ectopic Tachycardia evolving into complete heart block
Heart, 1998Co-Authors: H Henneveld, P Hutter, M Binkboelkens, Narayanswami SreeramAbstract:Transition from congenital Junctional Ectopic Tachycardia to complete AV block was observed in an 8 month old girl, over a 36 hour period, during initial hospital admission. Two years later she had evidence of a rapidly increasing left ventricular end diastolic diameter, associated with lowest heart rates during sleep of < 30 beats/min. A transvenous permanent pacemaker was therefore implanted. This finding supports the idea that a pathological process in the area of the AV junction, initially presenting as Junctional Ectopic Tachycardia may later extend to sudden complete atrioventricular block. Keywords: Junctional Ectopic Tachycardia; heart block; congenital heart disease; paediatrics
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Junctional Ectopic Tachycardia evolving into complete heart block
Heart (British Cardiac Society), 1998Co-Authors: H Henneveld, P Hutter, M Bink-boelkens, Narayanswami SreeramAbstract:Transition from congenital Junctional Ectopic Tachycardia to complete AV block was observed in an 8 month old girl, over a 36 hour period, during initial hospital admission. Two years later she had evidence of a rapidly increasing left ventricular end diastolic diameter, associated with lowest heart rates during sleep of
Andreas Entenmann - One of the best experts on this subject based on the ideXlab platform.
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Management of postoperative Junctional Ectopic Tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland
European Journal of Pediatrics, 2017Co-Authors: Andreas Entenmann, Miriam Michel, Friedemann Egender, Ulrike Herberg, Nikolaus Haas, Matthias Kumpf, Matthias Gass, Roman GebauerAbstract:Postoperative Junctional Ectopic Tachycardia (JET) is a frequent complication after pediatric cardiac surgery. Current recommendations on how and when to treat JET are inconsistent. We evaluated the management strategies of postoperative JET in German-speaking countries. We sent an online survey to 30 centers of pediatric cardiology that perform surgery for congenital heart defects in Germany (24), Austria (4), and Switzerland (2). The survey asked 18 questions about how and in what treatment sequence postoperative JET was managed. All 30 centers completed the survey (100% return rate). There was general agreement that the management of JET is based on administration of antiarrhythmic drugs, body surface cooling, and temporary pacing. Many centers presented treatment algorithms based on published literature, all centers named amiodarone as the first drug of choice. Significant disagreement was found concerning the timing and sequential order of additional therapeutic measures and particularly about the dosing of amiodarone and the role of R-wave synchronized atrial pacing. Conclusion : This survey reveals that from center to center, the treatment of postoperative JET may vary substantially. Future work should focus on those treatment modalities where a high rate of variation is found. Such studies may be of value to achieve commonly adopted treatment recommendations. What is known: • Treatment of postoperative Junctional Ectopic Tachycardia is predominantly based on administration of antiarrhythmic drugs, therapeutic cooling, and temporary pacing. • Amiodarone is the antiarrhythmic drug of choice in this context. What is new: • Dosing and duration of administration of amiodarone differ relevantly from center to center. • The sequential order of drug administration, therapeutic cooling, and pacing is not consistent.
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Management of postoperative Junctional Ectopic Tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland.
European journal of pediatrics, 2017Co-Authors: Andreas Entenmann, Nikolaus A. Haas, Miriam Michel, Friedemann Egender, Ulrike Herberg, Matthias Kumpf, Matthias Gass, Roman GebauerAbstract:Postoperative Junctional Ectopic Tachycardia (JET) is a frequent complication after pediatric cardiac surgery. Current recommendations on how and when to treat JET are inconsistent. We evaluated the management strategies of postoperative JET in German-speaking countries. We sent an online survey to 30 centers of pediatric cardiology that perform surgery for congenital heart defects in Germany (24), Austria (4), and Switzerland (2). The survey asked 18 questions about how and in what treatment sequence postoperative JET was managed. All 30 centers completed the survey (100% return rate). There was general agreement that the management of JET is based on administration of antiarrhythmic drugs, body surface cooling, and temporary pacing. Many centers presented treatment algorithms based on published literature, all centers named amiodarone as the first drug of choice. Significant disagreement was found concerning the timing and sequential order of additional therapeutic measures and particularly about the dosing of amiodarone and the role of R-wave synchronized atrial pacing.
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Impact of Different Diagnostic Criteria on the Reported Prevalence of Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery.
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Car, 2016Co-Authors: Andreas Entenmann, Miriam Michel, Friedemann Egender, Vera Hessling, Hans-heiner KramerAbstract:Objectives Junctional Ectopic Tachycardia is a frequent complication after pediatric cardiac surgery. A uniform definition of postoperative Junctional Ectopic Tachycardia has yet to be established in the literature. The objective of this study is to analyze differences in the general and age-related prevalence of postoperative Junctional Ectopic Tachycardia according to different diagnostic definitions. Design Data files and electrocardiograms of 743 patients (age, 1 d to 17.6 yr) who underwent surgery for congenital heart disease during a 3-year period were reviewed. The prevalence of postoperative Junctional Ectopic Tachycardia in this cohort was determined according to six different definitions identified in the literature and one definition introduced for analytical purposes. Agreement between the definitions was analyzed according to Cohen κ coefficients. A receiver operating characteristic analysis was performed to determine the ability of different definitions to discriminate between patients with increased postoperative morbidity and without. Setting A university-affiliated tertiary pediatric cardiac PICU. Patients Infants and children who underwent heart surgery. Interventions None. Measurements and main results The prevalence of postoperative Junctional Ectopic Tachycardia ranged from 2.0% to 8.3% according to the seven different definitions. Even among definitions for which the general prevalence was almost equal, the distribution according to age varied. Most definitions used a frequency criterion to define postoperative Junctional Ectopic Tachycardia. Definitions based on a fixed frequency criterion did not identify cases of postoperative Junctional Ectopic Tachycardia in patients older than 12 months. The grade of agreement was moderate or poor between definitions using a fixed or dynamic frequency criterion and those not based on a critical heart rate (κ = 0.37-0.66). In the receiver operating characteristic analysis, the definition with a fixed frequency criterion of 180 beats/min or an age-related frequency criterion according to the 95th percentile showed the optimal cut-off value to determine increased postoperative morbidity. Conclusions Different definitions of Junctional Ectopic Tachycardia after pediatric cardiac surgery lead to relevant differences in the reported prevalence and age distribution pattern. A uniform definition of postoperative Junctional Ectopic Tachycardia is needed to provide comparable study results and to improve the diagnosis of Junctional Ectopic Tachycardia in pediatric patients.
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Strategies for Temporary Cardiac Pacing in Pediatric Patients With Postoperative Junctional Ectopic Tachycardia.
Journal of cardiothoracic and vascular anesthesia, 2015Co-Authors: Andreas Entenmann, Miriam MichelAbstract:POSTOPERATIVE Junctional Ectopic Tachycardia (JET) occurs in 6% to 14% of all pediatric patients after surgery for repair of congenital heart defects. In combination with postoperative systolic and diastolic ventricular dysfunction, the Tachycardia and the absence of synchrony of atrial and ventricular contraction result in relevant hemodynamic compromise. Without adequate treatment, such rhythm disorder is associated with increased morbidity and mortality. Therapy for JET comprises administration of antiarrhythmic drugs, deep sedation, and induced hypothermia. Temporary pacing is a further important pillar of treatment. Different techniques of temporary pacing exist that aim either to reduce the effective heart rate or to resynchronize atrial and ventricular contraction. The aim of this article is to describe 4 different strategies of external cardiac pacing in pediatric patients with postoperative JET (atrial demand pacing [AAI], dual-chamber pacing [DDD], paired ventricular pacing [PVP], and ventricular-triggered atrial pacing [AVT]). Advantages and disadvantages of the described strategies will be discussed.
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R-wave synchronised atrial pacing in post-operative Junctional Ectopic Tachycardia using a transoesophageal pacemaker.
Cardiology in The Young, 2012Co-Authors: Andreas Entenmann, Katja Reineker, Hans-heiner KramerAbstract:: 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.
Richard A. Jonas - One of the best experts on this subject based on the ideXlab platform.
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Magnesium Lowers the Incidence of Postoperative Junctional Ectopic Tachycardia in Congenital Heart Surgical Patients: Is There a Relationship to Surgical Procedure Complexity?
Pediatric Cardiology, 2015Co-Authors: Nathaniel Sznycer-taub, Robert Mccarter, Richard A. Jonas, Yao Cheng, Sridhar Hanumanthaiah, Jeffrey P. MoakAbstract: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
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Postoperative Junctional Ectopic Tachycardia: risk factors for occurrence in the modern surgical era.
Pacing and clinical electrophysiology : PACE, 2013Co-Authors: Jeffrey P. Moak, Robert Mccarter, Gerard R. Martin, Sridhar Hanumanthaiah, Patricio Arias, Jonathan R. Kaltman, Yao I. Cheng, Richard A. JonasAbstract:Background Postoperative (PO) Junctional Ectopic Tachycardia (JET) can be a life-threatening arrhythmia that follows surgical repair of congenital heart disease (CHD) and results in PO morbidity. Methods We reviewed 750 open heart surgeries (OHS) for CHD performed between January 2005 and February 2009. Kaplan-Meier and Cox proportional hazards model analyses were used to estimate the frequency and evaluate risk factors that might predict JET occurrence. Results The patients ranged in age from 1 day to 36.6 years; half were less than 4.8 months at the time of OHS. JET occurred in 115 of 750 (15.3%) OHS. JET was bimodally distributed by age with a peak incidence between 1–2 weeks and 1–3 years. JET occurred more commonly: (1) in specific types of OHS (single ventricle [19.5%] and cono-truncal defects [19.3%]) (P = 0.03); (2) with increased total surgical time (P = 0.001), aortic cross-clamp time (P < 0.001), cardiopulmonary bypass time (P < 0.001); and (3) followed use of inotropic agents (dopamine or milrinone, P < 0.001). JET lengthened intensive care stay by 3 days (P = 0.0001) and increased mortality (+JET [9.6%] vs –JET [4.6%], P = 0.03). In a multiple variable Cox regression model, total surgical time and PO use of milrinone were the best predictors for JET risk. PO administration of nitroprusside decreased risk of JET. Conclusions JET occurred more commonly following OHS associated with prolonged surgical times and PO use of inotropic medications. In contrast to previous reports, our results suggest that mechanical injury to the atrioventricular node area is not strongly associated with JET.
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Newly created animal model of human postoperative Junctional Ectopic Tachycardia.
The Journal of thoracic and cardiovascular surgery, 2012Co-Authors: Jeffrey P. Moak, Marco A. Mercader, Tk. Susheel Kumar, Gregory D. Trachiotis, Robert Mccarter, Richard A. JonasAbstract:Objective Junctional Ectopic Tachycardia complicates the postoperative recovery from open heart surgery in children. The reported risk factors include younger age, prolonged cardiopulmonary bypass times, and administration of inotropic agents. Junctional Ectopic Tachycardia occurs early after open heart surgery, in the setting of relative postoperative sinus node dysfunction, and exhibits QRS morphology consistent with an origin from the atrioventricular node or proximal conduction system. Our goal was to develop a reproducible animal model for postoperative Junctional Ectopic Tachycardia. Methods Eleven pigs, aged 2 to 4 months, underwent open heart surgery after induction of general anesthesia. Electrodes were sewn to the left atrium and right ventricle. Results Sinus node dysfunction was created using clamp crushing without or with radiofrequency ablation (successful in 1 of 5 pigs) or sinus node removal (successful in 4 of 4). After prolonged cardiopulmonary bypass (>120 minutes) alone and with isoproterenol infusion, no spontaneous Junctional Ectopic Tachycardia developed. Junctional Ectopic Tachycardia or fascicular Tachycardia could be initiated after either slow atrioventricular nodal pathway ablation and/or digoxin administration. Junctional Ectopic Tachycardia occurred in 8 of 9 pigs (mean ventricular rate, 171 ± 32 bpm), and fascicular Tachycardia occurred in 9 of 9 pigs (mean ventricular rate, 187 ± 39 bpm). His and right bundle recordings confirmed the conduction system origin. Conclusions Experimental Junctional Ectopic Tachycardia or fascicular Tachycardia can occur in the intraoperative setting of sinus node dysfunction, prolonged cardiopulmonary bypass, and enhanced conduction system automaticity. Conduction system automaticity occurred after either physical injury (ablation or tricuspid valve stretch) or measures to augment the transient inward current of the conduction system (isoproterenol and digoxin). This animal model can serve as the basis to assess new treatments of postoperative Junctional Ectopic Tachycardia.
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Abstract 11973: Newly Created Animal Model of Human Post-Operative Junctional Ectopic Tachycardia
Circulation, 2011Co-Authors: Jeffrey P. Moak, Marco A. Mercader, Gregory D. Trachiotis, Henry Blicharz, Gerard R. Martin, Richard A. JonasAbstract:Introduction: Junctional Ectopic Tachycardia (JET) complicates the post-operative (PO) recovery from open heart surgery (OHS) in children (5-15% incidence). JET risk factors include younger age, an...
Miriam Michel - One of the best experts on this subject based on the ideXlab platform.
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Management of postoperative Junctional Ectopic Tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland
European Journal of Pediatrics, 2017Co-Authors: Andreas Entenmann, Miriam Michel, Friedemann Egender, Ulrike Herberg, Nikolaus Haas, Matthias Kumpf, Matthias Gass, Roman GebauerAbstract:Postoperative Junctional Ectopic Tachycardia (JET) is a frequent complication after pediatric cardiac surgery. Current recommendations on how and when to treat JET are inconsistent. We evaluated the management strategies of postoperative JET in German-speaking countries. We sent an online survey to 30 centers of pediatric cardiology that perform surgery for congenital heart defects in Germany (24), Austria (4), and Switzerland (2). The survey asked 18 questions about how and in what treatment sequence postoperative JET was managed. All 30 centers completed the survey (100% return rate). There was general agreement that the management of JET is based on administration of antiarrhythmic drugs, body surface cooling, and temporary pacing. Many centers presented treatment algorithms based on published literature, all centers named amiodarone as the first drug of choice. Significant disagreement was found concerning the timing and sequential order of additional therapeutic measures and particularly about the dosing of amiodarone and the role of R-wave synchronized atrial pacing. Conclusion : This survey reveals that from center to center, the treatment of postoperative JET may vary substantially. Future work should focus on those treatment modalities where a high rate of variation is found. Such studies may be of value to achieve commonly adopted treatment recommendations. What is known: • Treatment of postoperative Junctional Ectopic Tachycardia is predominantly based on administration of antiarrhythmic drugs, therapeutic cooling, and temporary pacing. • Amiodarone is the antiarrhythmic drug of choice in this context. What is new: • Dosing and duration of administration of amiodarone differ relevantly from center to center. • The sequential order of drug administration, therapeutic cooling, and pacing is not consistent.
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Management of postoperative Junctional Ectopic Tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland.
European journal of pediatrics, 2017Co-Authors: Andreas Entenmann, Nikolaus A. Haas, Miriam Michel, Friedemann Egender, Ulrike Herberg, Matthias Kumpf, Matthias Gass, Roman GebauerAbstract:Postoperative Junctional Ectopic Tachycardia (JET) is a frequent complication after pediatric cardiac surgery. Current recommendations on how and when to treat JET are inconsistent. We evaluated the management strategies of postoperative JET in German-speaking countries. We sent an online survey to 30 centers of pediatric cardiology that perform surgery for congenital heart defects in Germany (24), Austria (4), and Switzerland (2). The survey asked 18 questions about how and in what treatment sequence postoperative JET was managed. All 30 centers completed the survey (100% return rate). There was general agreement that the management of JET is based on administration of antiarrhythmic drugs, body surface cooling, and temporary pacing. Many centers presented treatment algorithms based on published literature, all centers named amiodarone as the first drug of choice. Significant disagreement was found concerning the timing and sequential order of additional therapeutic measures and particularly about the dosing of amiodarone and the role of R-wave synchronized atrial pacing.
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Impact of Different Diagnostic Criteria on the Reported Prevalence of Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery.
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Car, 2016Co-Authors: Andreas Entenmann, Miriam Michel, Friedemann Egender, Vera Hessling, Hans-heiner KramerAbstract:Objectives Junctional Ectopic Tachycardia is a frequent complication after pediatric cardiac surgery. A uniform definition of postoperative Junctional Ectopic Tachycardia has yet to be established in the literature. The objective of this study is to analyze differences in the general and age-related prevalence of postoperative Junctional Ectopic Tachycardia according to different diagnostic definitions. Design Data files and electrocardiograms of 743 patients (age, 1 d to 17.6 yr) who underwent surgery for congenital heart disease during a 3-year period were reviewed. The prevalence of postoperative Junctional Ectopic Tachycardia in this cohort was determined according to six different definitions identified in the literature and one definition introduced for analytical purposes. Agreement between the definitions was analyzed according to Cohen κ coefficients. A receiver operating characteristic analysis was performed to determine the ability of different definitions to discriminate between patients with increased postoperative morbidity and without. Setting A university-affiliated tertiary pediatric cardiac PICU. Patients Infants and children who underwent heart surgery. Interventions None. Measurements and main results The prevalence of postoperative Junctional Ectopic Tachycardia ranged from 2.0% to 8.3% according to the seven different definitions. Even among definitions for which the general prevalence was almost equal, the distribution according to age varied. Most definitions used a frequency criterion to define postoperative Junctional Ectopic Tachycardia. Definitions based on a fixed frequency criterion did not identify cases of postoperative Junctional Ectopic Tachycardia in patients older than 12 months. The grade of agreement was moderate or poor between definitions using a fixed or dynamic frequency criterion and those not based on a critical heart rate (κ = 0.37-0.66). In the receiver operating characteristic analysis, the definition with a fixed frequency criterion of 180 beats/min or an age-related frequency criterion according to the 95th percentile showed the optimal cut-off value to determine increased postoperative morbidity. Conclusions Different definitions of Junctional Ectopic Tachycardia after pediatric cardiac surgery lead to relevant differences in the reported prevalence and age distribution pattern. A uniform definition of postoperative Junctional Ectopic Tachycardia is needed to provide comparable study results and to improve the diagnosis of Junctional Ectopic Tachycardia in pediatric patients.
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Strategies for Temporary Cardiac Pacing in Pediatric Patients With Postoperative Junctional Ectopic Tachycardia.
Journal of cardiothoracic and vascular anesthesia, 2015Co-Authors: Andreas Entenmann, Miriam MichelAbstract:POSTOPERATIVE Junctional Ectopic Tachycardia (JET) occurs in 6% to 14% of all pediatric patients after surgery for repair of congenital heart defects. In combination with postoperative systolic and diastolic ventricular dysfunction, the Tachycardia and the absence of synchrony of atrial and ventricular contraction result in relevant hemodynamic compromise. Without adequate treatment, such rhythm disorder is associated with increased morbidity and mortality. Therapy for JET comprises administration of antiarrhythmic drugs, deep sedation, and induced hypothermia. Temporary pacing is a further important pillar of treatment. Different techniques of temporary pacing exist that aim either to reduce the effective heart rate or to resynchronize atrial and ventricular contraction. The aim of this article is to describe 4 different strategies of external cardiac pacing in pediatric patients with postoperative JET (atrial demand pacing [AAI], dual-chamber pacing [DDD], paired ventricular pacing [PVP], and ventricular-triggered atrial pacing [AVT]). Advantages and disadvantages of the described strategies will be discussed.
