EFFECT OF JUNCTIONAL ECTOPIC TACHYCARDIA ON POSTOPERATIVE MORBIDITY FOLLOWING REPAIR OF CONGENITAL HEART DEFECTS
Sachdev MS*, Suresh kumar R**, Coelhi R ***
Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai *, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai **, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai ***
Aim
To determine the incidence of postoperative junctional ectopic tachycardia (JET) and its effect on morbidity following repair of congenital heart defects.
Methods
We reviewed the postoperative course of 394 consecutive patients undergoing surgery for Ventricular Septal Defect (VSD), Tetralogy of Fallot (TOF). Atrioventricular Septal Defect (AVSD) and common arterial trunk at our institute during the period from October 2003 to March 2005. All patients with JET received treatment in stepwise manner, surface cooling, continuous intravenous amiodarone and/or atrial pacing if hemodynamically unstable. The effect of JET and treatment on duration of mechanical ventilation and cardiac intensive care unit (CICU) stay was analyzed.
Results
There was no mortality, JET occurred in 29 patients (7.3%), most frequently following TOF repair (23.6%), followed by AVSD (14.3%), VSD (2.4%) and 1 patient had following repair of the common arterial trunk. Mean ventilation time increased from 71 hours vs. 113 hours in patients without and with JET respectively. Surface cooling was associated with increase in the CICU time by 64 hours. Amiodarone prolonged the CICU stay and mean ventilation time by 83 and 49 hours respectively.
Conclusion
Postoperative JET adds to the morbidity following congenital cardiac surgery and is the most common following TOF repair. Early initiation of treatment is mandatory but results in prolonged ventilation times and CICU stays. Early recognition and in depth understanding of mechanism is required to achieve prevention, faster control and reduction of associated morbidity.
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