Junctional ectopic tachycardia after surgery for congenital heart disease in children

Abstract

Objective: To determine incidence, predictors and outcome [intensive care unit (ICU) mortality and length of stay (LOS)] after postoperative junctional ectopic tachycardia (JET) in an unselected paediatric population.

Design: Patients with JET (n=89) were compared with non-JET controls (n=178) in a nested case-control study.

Setting: Tertiary ICU at Skejby Sygehus, Aarhus University Hospital, Denmark.

Patients: The patient records of all children (n=874) who underwent corrective cardiac surgery on cardio-pulmonary bypass (CPB) between 1998 and 2005 were reviewed for postoperative JET.

Methods and results: The association between JET and its potential predictors was examined with multivariate conditional regression analyses. The overall incidence of JET was 10.2%. CPB duration>90 min [adjusted odds ratio (OR) 2.6; 95% confidence interval (CI) 1.1-6.5], high inotropic requirements (adjusted OR 2.6; CI 1.2-5.9) and high postoperative levels of creatine kinase (CK)-MB (adjusted OR 3.1; CI 1.3-7.1) were associated with an increased risk of JET. ICU mortality was higher for patients with JET (13.5%; CI 7.2-22.4%) than for controls (1.7%; CI 0.3-4.8%), and LOS in ICU was 3 times higher in JET patients (median 2 vs. 7 days, p<0.001).

Conclusions: JET occurred in approximately 10% of children following cardiac surgery and was associated with higher mortality and longer ICU stay. Risk factors included high inotropic requirements after surgery and extensive myocardial injury in terms of high CK-MB values and longer CPB duration.