Management of postoperative junctional ectopic tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland

• Published in: European journal of pediatrics 2017-09, Vol.176 (9), p.1217-1226
• Main Authors: Entenmann, Andreas, Michel, Miriam, Herberg, Ulrike, Haas, Nikolaus, Kumpf, Matthias, Gass, Matthias, Egender, Friedemann, Gebauer, Roman
• Format: Article
• Language: English
• Subjects: Amiodarone; Amiodarone - administration & dosage; Anti-Arrhythmia Agents - administration & dosage; Arrhythmia; Austria; Cardiac arrhythmia; Cardiac Pacing, Artificial - methods; Cardiac Surgical Procedures - adverse effects; Child; Cryotherapy - methods; Germany; Health Care Surveys; Heart diseases; Heart surgery; Humans; Infant; Medicine; Medicine & Public Health; Original Article; Pediatrics; Postoperative Complications - therapy; Switzerland; Tachycardia; Tachycardia, Ectopic Junctional - prevention & control; Tachycardia, Ectopic Junctional - therapy
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-017-2969-x

Postoperative junctional ectopic tachycardia (JET) is a frequent complication after pediatric cardiac surgery. Current recommendations on how and when to treat JET are inconsistent. We evaluated the management strategies of postoperative JET in German-speaking countries. We sent an online survey to 30 centers of pediatric cardiology that perform surgery for congenital heart defects in Germany (24), Austria (4), and Switzerland (2). The survey asked 18 questions about how and in what treatment sequence postoperative JET was managed. All 30 centers completed the survey (100% return rate). There was general agreement that the management of JET is based on administration of antiarrhythmic drugs, body surface cooling, and temporary pacing. Many centers presented treatment algorithms based on published literature, all centers named amiodarone as the first drug of choice. Significant disagreement was found concerning the timing and sequential order of additional therapeutic measures and particularly about the dosing of amiodarone and the role of R-wave synchronized atrial pacing. Conclusion : This survey reveals that from center to center, the treatment of postoperative JET may vary substantially. Future work should focus on those treatment modalities where a high rate of variation is found. Such studies may be of value to achieve commonly adopted treatment recommendations. What is known: • Treatment of postoperative junctional ectopic tachycardia is predominantly based on administration of antiarrhythmic drugs, therapeutic cooling, and temporary pacing. • Amiodarone is the antiarrhythmic drug of choice in this context. What is new: • Dosing and duration of administration of amiodarone differ relevantly from center to center. • The sequential order of drug administration, therapeutic cooling, and pacing is not consistent.