Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Ann Thorac Surg. 2024 Jun;117(6):1178-1185. doi: 10.1016/j.athoracsur.2024.03.002. Epub 2024 Mar 12.
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.
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.
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.
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.
交界性心动过速（JET）在 2%至 8.3%的先天性心脏病手术中并发。在单中心研究中，JET 与术后发病率有关。我们使用儿科心脏危重病护理联合会的数据登记处，提供了一个治疗 JET 的多中心流行病学描述。
这是一项对接受治疗的 JET 患者的回顾性研究（2019 年 2 月至 2022 年 8 月）。纳入标准为：（1）索引手术时<12 个月龄，（2）手术后<72 小时接受 JET 治疗。诊断定义为接受治疗（起搏、冷却和药物治疗）。使用医院随机效应的多水平逻辑回归分析确定 JET 的危险因素。使用先前的风险调整模型，通过边际/归因风险分析估计 JET 对结果的影响。
在 63 个中心的 24073 名患者中，有 1436 名（6.0%）因 JET 接受治疗，且存在显著的中心变异性（0%至 17.9%）。发病中位时间为 3.4 小时，34%的患者在入院时就存在。中位持续时间为 2 天（四分位间距，1-4 天）。法洛四联症、房室管和室间隔缺损修复占 JET 的 50%以上。与 JET 独立相关的患者特征包括新生儿年龄、亚洲种族、体外循环时间、胸骨切开术和术后早期正性肌力药物。JET 与机械通气时间（发病率比，1.6；95%置信区间，1.5-1.7）和重症监护病房住院时间（发病率比，1.3；95%置信区间，1.2-1.3）的风险调整后延长有关，但与死亡率无关。
JET 治疗在 6%的患者中，且存在很大的中心变异性。JET 导致术后资源使用增加。高中心变异性需要进一步研究，以确定潜在的可修改因素，作为改善努力的目标，以减轻不良结果。
