Abstract 20695: Junctional Ectopic Tachycardia in Recent Surgical Era : Clinical Epidemiology, Risk Factors & Outcomes
Background: JET is common after congenital heart surgeries & has been associated with high mortality (up to 14%). We aim to report JET incidence, risk factors & outcomes in the current era.
Methods: Retrospective analysis of cardiac surgical patients less than 18 years of age over a six year period. When available, for each JET patient, two controls with similar lesions, repair type & no post operative arrhythmias were studied for pre, intra & post operative variables.
Results: We identified 104 patients with JET (incidence of 6 %). Majority of cases occurred after surgeries known as high risk for JET; VSDs including those with DORV , AVSD were the commonest lesions (35/104), followed by TOF (20/104) & TGA 11/104. Other cases occurred after surgeries that are not traditionally known to be associated with JET; TAPVC repair (3 cases with rate of 3 %), BT shunt (2 cases with rate of 1 %) & Fontan (1 case with rate of 2 %). Onset of JET was within first 24 hours after surgery in 74 % of patients, & lasted for less than 48 hours in the majority of cases. After multivariate logistic regression analysis, patient’s weight at time of surgery, less than 4 Kg [adjusted OR 3.97, 95% confidence interval (CI) 1.25-12.63], CPB duration > 100 min [adjusted OR 4.07; 95% CI 1.40-11.77], & postoperative lactic acid higher than 20 mg/dl (adjusted OR 5.64; 95% CI 1.88-16.93) were associated with an increased risk of JET. Amiodarone was the most commonly used specific therapy in JET ( 49/104), followed by procainamide in 14/104, esmolol 4/104, dexmedetomidine 14/104. Pacing (65/104) was an important adjuvant therapy. JET patients also had 3 times longer ICU stay, 3 times longer mechanical ventilation time & 1.5 times longer hospital stay therefore adding to significant healthcare cost burden. Overall, early mortality was very low (2/104) & comparable to patients without JET.
Conclusion: This is the largest cohort to date. Small patients with a long CPB time & high post-operative lactic acidosis are at high risk of developing JET with very significant morbidity & cost, but very low mortality. Future studies to assess efficacy of preventive measures in high risk patients are needed.
Author Disclosures: S. Alam: None. A. Kane: None. K.O. Maher: None. P. Fischbach: None. S.R. Deshpande: None.
- © 2016 by American Heart Association, Inc.