Amiodarone management of junctional ectopic tachycardia after cardiac surgery in children.

OBJECTIVE

To assess the effectiveness and safety of amiodarone in the treatment of junctional ectopic tachycardia (JET) after open heart surgery in children.

PATIENTS

Between January 1990 and December 1991, 16 consecutive patients aged 6 days to 14 years with JET associated with significant haemodynamic impairment after cardiopulmonary bypass were treated with amiodarone as the principal antiarrhythmic drug.

INTERVENTIONS

Amiodarone 5 mg/kg was administered intravenously over one hour and the same dose was subsequently infused over 12 hours. This was reviewed every 12 hours and repeated as necessary until a satisfactory heart rate and stable haemodynamics were achieved. Atrial pacing was used whenever possible to provide atrioventricular synchrony.

RESULTS

Except for one patient with a JET rate of 160/min, the maximum JET rate ranged from 180/min to 245/min with a mean(SD) of 200 (20)/min. After amiodarone, the heart rates reduced to a mean(SD) of 170 (20), 164 (27), 158 (27), 157 (24), and 153 (19)/min at two, four, eight, 12, and 24 hours respectively. A reduction in tachycardia rate allowing atrial pacing was achieved in 10 patients by two hours. Haemodynamic variables improved in most patients with an increase in mean systolic blood pressure by an average of 15 mm Hg and a decrease in atrial filling pressures by an average of 3.5 mm Hg at four hours after amiodarone administration. There were three deaths: one was a moribund patient who died soon after the onset of JET and the other two deaths were not directly related to JET.

COMPLICATIONS

Late bradycardia with hypotension was recorded in one patient. Asymptomatic late sinus bradycardia was seen in several others.

CONCLUSIONS

Amiodarone can be used safely and effectively to control JET with haemodynamic improvement in most patients. The addition of atrial pacing confers the advantage of atrioventricular synchrony.