Junctional Ectopic Tachycardia After Congenital Heart Surgery: Incidence, Risk Factors, and Outcomes

OBJECTIVE
Postoperative junctional ectopic tachycardia (JET) is usually a self-limiting condition; however, when combined with atrioventricular dissociation and postoperative ventricular dysfunction, it may increase morbidity and mortality. This study aimed to determine the overall incidence of JET following congenital heart surgery, to identify patient and procedure-related risk factors, and to evaluate the clinical impact of JET on outcomes.


METHODS
The records of 2,814 patients who underwent cardiac surgery over a five-year period were reviewed retrospectively to identify those with JET. For each patient diagnosed with JET, two controls who underwent surgery during the same period were selected to compare possible risk factors and outcomes.


RESULTS
The incidence of JET following congenital heart surgery was 2.66% in this large cohort. Univariate analyses revealed statistically significant associations between JET and factors such as young age, small body weight, high vasoactive inotropic score, operations involving the ventricular septum, surgical complexity score, increased cardiopulmonary bypass time, delayed sternal closure, extracorporeal membrane oxygenation (ECMO) requirement, and increased risk of postoperative JET. In multivariate analysis only the association between surgeries involving the ventricular septum, ECMO requirement, and increased risk of JET persisted. Compared to controls, patients with JET experienced prolonged intubation times, longer stays in the intensive care unit and hospital, more frequent unplanned re-interventions, and higher mortality rates.


CONCLUSION
Junctional ectopic tachycardia can lead to serious hemodynamic consequences in patients following congenital heart surgery and is associated with poorer clinical outcomes. Both patient and procedure-related factors contribute to the overall risk of developing JET. Identifying associations and predictors of JET can help improve patient outcomes.