Paluszek Corinna, Brenner Paolo, Pichlmaier Maximilian, Haas Nikolaus A, Dalla-Pozza Robert, Hagl Christian, Hakami Lale
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.
World J Pediatr Congenit Heart Surg. 2019 Jan;10(1):50-57. doi: 10.1177/2150135118813124.
Junctional ectopic tachycardia (JET) is a common arrhythmia causing hemodynamic impairment following corrective cardiac surgery such as tetralogy of Fallot (TOF) repair.
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.
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.
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.
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.
交界性异位性心动过速（JET）是一种常见的心律失常，在诸如法洛四联症（TOF）修复等心脏矫正手术后会导致血流动力学损害。
我们报告了TOF手术修复后发生术后JET的经验。这项回顾性研究于2003年至2012年进行，共有105例接受TOF修复的患者。对这些患者的临床和心电图数据（术前、术中及术后）进行监测，以确定JET发生的危险因素，并评估受影响患者的结局。
发生率——14例患者发生JET，只有4例患者直接从窦性心律转变为JET。在所有其他患者中，JET之前出现短暂房室（AV）阻滞或交界性心律，大多在术中出现，显示出显著相关性（P = 0.010）。年龄——发生JET的患者年龄较小（P = 0.025），体外循环时间较长（P = 0.044），主动脉阻断时间较长（P = 0.038）。成本和护理增加——JET的发生与在重症监护病房（ICU）停留时间延长、对血管活性药物支持和机械通气的需求延长有关。心率控制时间与ICU和住院时间相关。
所有JET患者均转为窦性心律，其中1例在JET停止后不久死亡，2例患者随后出现一度AV阻滞。
JET的发生在术后初期仍然是一个重要的并发症，会增加机械通气时间、对血管活性药物支持的需求，并延长ICU和住院时间。危险因素包括年龄较小、主动脉阻断/体外循环时间较长以及术中心律失常。
