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 in combination with atrioventricular dissociation and postoperative ventricular dysfunction, it may increase morbidity and mortality. The present study aimed to find the overall incidence of JET following congenital heart surgery, to determine patient and procedure-related risk factors for JET, and to evaluate the clinical impact of JET on outcomes.


METHOD
The records of 2814 patients, who underwent cardiac surgery during 5 year period, were reviewed retrospectively to identify patients with JET. For each patient with JET, two controls who underwent surgery during the same period were chosen to compare with JET patients regarding possible risk factors and outcomes.


RESULTS
The incidence of JET following congenital heart surgery was 2.66 % in this large group of patients. Univariate analyses showed statistically significant associations between young age, small body weight, high vasoactive inotrope score, operations involving ventricular septum, surgical complexity score, increased cardiopulmonary bypass time, delayed sternal closure, ECMO requirement, and increased risk of postoperative JET. Following multivariate analysis, only the association between surgeries that involve ventricular septum, ECMO requirement, and increased risk of JET persisted. Compared with controls, JET patients had prolonged lengths of intubation, longer intensive care unit and hospital stays, frequent unplanned re-interventions, and higher mortality.


CONCLUSION
JET can cause serious hemodynamic consequences in patients following congenital heart surgery, and is associated with worse clinical outcomes. Both patient and procedure related factors contribute to the overall risk of developing JET. Describing associations and predictors of JET can help to improve outcomes.