Ismail Mohamed Fouad, Arafat Amr A, Hamouda Tamer E, El Tantawy Amira Esmat, Edrees Azzahra, Bogis Abdulbadee, Badawy Nashwa, Mahmoud Alaa B, Elmahrouk Ahmed Farid, Jamjoom Ahmed A
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.
J Cardiothorac Surg. 2018 Jun 5;13(1):60. doi: 10.1186/s13019-018-0749-y.
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.
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.
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).
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.
交界性异位性心动过速是法洛四联症修复术后常见的严重心律失常。并非所有小儿心脏手术患者都可行心律失常预防，因此需要识别高危患者。本研究的目的是对交界性异位性心动过速患者进行特征分析，确定其预测因素、后续并发症以及各种治疗策略对2岁前接受完全修复的特定法洛四联症患者预后的影响。
2003年至2017年，609例患者接受了法洛四联症修复术，其中322例纳入本研究。我们排除了2岁以上患者及术前有心律失常的患者。29.8%的患者（n = 96）术后发生交界性异位性心动过速。
交界性异位性心动过速患者年龄更小，术前心率更高。交界性异位性心动过速的独立预测因素为年龄小、术前心率高、发绀发作、未使用β受体阻滞剂以及低镁和低钙（p分别为0.011、0.018、0.024、0.001、0.004和0.001）。交界性异位性心动过速不影响机械通气时间和住院时间（p分别为0.12和0.2），但延长了重症监护病房（ICU）住院时间（p = 0.011）。39.5%（n = 38）的患者对常规措施有反应，交界性异位性心动过速得到缓解。31.25%（n = 30）的患者使用了胺碘酮，其使用与更长的ICU住院时间相关（p = 0.017）。4例患者（5.2%）需要心室起搏。交界性异位性心动过速的中位持续时间为30.5小时，5例患者有交界性异位性心动过速复发。交界性异位性心动过速发作时间不影响ICU住院时间（p = 0.43）或住院时间（p = 0.14），然而，交界性异位性心动过速持续时间长会增加ICU住院时间和住院时间（p分别为0.02和0.009）。
法洛四联症修复术后，交界性异位性心动过速会增加ICU住院时间。术前使用β受体阻滞剂可显著减少交界性异位性心动过速。有术前危险因素的患者可从术前心律失常预防中获益，积极处理术后电解质紊乱至关重要。
