Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AAI:

Atrial demand pacing

AKKI:

Arbeitsgemeinschaft kinderkardiologische Intensivmedizin

AV:

Atrioventricular

AVT:

R-wave synchronized atrial pacing

bpm:

Beats per minute

CPB:

Cardiopulmonary bypass

DDD:

Dual chamber pacing

DGPK:

Deutsche Gesellschaft für Pädiatrische Kardiologie

JET:

Junctional ectopic tachycardia

PCICU:

Pediatric cardiac intensive care unit

SR:

Sinus rhythm

VVI:

Ventricular demand pacing

References

  1. Abdelaziz O, Deraz S (2014) Anticipation and management of junctional ectopic tachycardia in postoperative cardiac surgery: single center experience with high incidence. Ann Pediatr Cardiol 7:19–24

    Article  PubMed  PubMed Central  Google Scholar 

  2. Amrousy DE, Elshehaby W, Feky WE, Elshmaa NS (2016) Safety and efficacy of prophylactic amiodarone in preventing early junctional ectopic tachycardia (JET) in children after cardiac surgery and determination of its risk factor. Pediatr Cardiol 37:734–739

    Article  PubMed  Google Scholar 

  3. Balaji S, Sullivan I, Deanfield J, James I (1991) Moderate hypothermia in the management of resistant automatic tachycardias in children. Br Heart J 66:221–224

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bash SE, Shah JJ, Albers WH, Geiss DM (1987) Hypothermia for the treatment of postsurgical greatly accelerated junctional ectopic tachycardia. J Am Coll Cardiol 10:1095–1099

    Article  CAS  PubMed  Google Scholar 

  5. Batra AS, Chun DS, Johnson TR, Maldonado EM, Kashyap BA, Maiers J, Lindblade CL, Rodefeld M, Brown JW, Hubbard JE (2006) A prospective analysis of the incidence and risk factors associated with junctional ectopic tachycardia following surgery for congenital heart disease. Pediatr Cardiol 27:51–55

    Article  CAS  PubMed  Google Scholar 

  6. Bernstein AD, Daubert JC, Fletcher RD, Hayes DL, Luderitz B, Reynolds DW, Schoenfeld MH, Sutton R (2002) The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol 25:260–264

    Article  PubMed  Google Scholar 

  7. Borgman KY, Smith AH, Owen JP, Fish FA, Kannankeril PJ (2011) A genetic contribution to risk for postoperative junctional ectopic tachycardia in children undergoing surgery for congenital heart disease. Heart Rhythm 8:1900–1904

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bronzetti G, Formigari R, Giardini A, Frascaroli G, Gargiulo G, Picchio FM (2003) Intravenous flecainide for the treatment of junctional ectopic tachycardia after surgery for congenital heart disease. Ann Thorac Surg 76:148–151

    Article  PubMed  Google Scholar 

  9. Chrysostomou C, Beerman L, Shiderly D, Berry D, Morell VO, Munoz R (2008) Dexmedetomidine: a novel drug for the treatment of atrial and junctional tachyarrhythmias during the perioperative period for congenital cardiac surgery: a preliminary study. Anesth Analg 107:1514–1522

    Article  CAS  PubMed  Google Scholar 

  10. Danzl DF, Pozos RS (1994) Accidental hypothermia. N Engl J Med 331:1756–1760

    Article  CAS  PubMed  Google Scholar 

  11. Delaney JW, Moltedo JM, Dziura JD, Kopf GS, Snyder CS (2006) Early postoperative arrhythmias after pediatric cardiac surgery. J Thorac Cardiovasc Surg 131:1296–1300

    Article  PubMed  Google Scholar 

  12. Dodge-Khatami A, Miller OI, Anderson RH, Gil-Jaurena JM, Goldman AP, de Leval MR (2002) Impact of junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects. Eur J Cardiothorac Surg 21:255–259

    Article  CAS  PubMed  Google Scholar 

  13. Dodge-Khatami A, Miller OI, Anderson RH, Goldman AP, Gil-Jaurena JM, Elliott MJ, Tsang VT, De Leval MR (2002) Surgical substrates of postoperative junctional ectopic tachycardia in congenital heart defects. J Thorac Cardiovasc Surg 123:624–630

    Article  PubMed  Google Scholar 

  14. Dorman BH, Sade RM, Burnette JS, Wiles HB, Pinosky ML, Reeves ST, Bond BR, Spinale FG (2000) Magnesium supplementation in the prevention of arrhythmias in pediatric patients undergoing surgery for congenital heart defects. Am Heart J 139:522–528

    Article  CAS  PubMed  Google Scholar 

  15. El Amrousy DM, Elshmaa NS, El-Kashlan M, Hassan S, Elsanosy M, Hablas N, Elrifaey S, El-Feky W (2017) Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia after pediatric cardiac surgery. J Am Heart Assoc 6:e004780. doi:10.1161/JAHA.116004780

    Article  PubMed  PubMed Central  Google Scholar 

  16. El-Shmaa NS, El Amrousy D, El Feky W (2016) The efficacy of pre-emptive dexmedetomidine versus amiodarone in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery. Ann Card Anaesth 19:614–620

    Article  PubMed  PubMed Central  Google Scholar 

  17. Entenmann A, Michel M (2016) Strategies for temporary cardiac pacing in pediatric patients with postoperative junctional ectopic tachycardia. J Cardiothorac Vasc Anesth 30:217–221

    Article  PubMed  Google Scholar 

  18. Entenmann A, Michel M, Egender F, Hessling V, Kramer HH (2016) Impact of different diagnostic criteria on the reported prevalence of junctional ectopic tachycardia after pediatric cardiac surgery. Pediatr Crit Care Med 17:845–851

    Article  PubMed  Google Scholar 

  19. Entenmann A, Schmiedel R, Michel M, Egender F, Hessling V, Dahnert I, Gebauer R (2016) A low-cost simulation model for R-wave synchronized atrial pacing in pediatric patients with postoperative junctional ectopic tachycardia. PLoS One 11:e0150704

    Article  PubMed  PubMed Central  Google Scholar 

  20. Erickson SJ (2016) Guidelines for the management of junctional ectopic tachycardia following cardiag surgery in children. Curr Paediatr 16:275–278

    Article  Google Scholar 

  21. Garson A Jr, Moak JP, Smith RT Jr, Norton JB Jr (1987) Usefulness of intravenous propafenone for control of postoperative junctional ectopic tachycardia. Am J Cardiol 59:1422–1424

    Article  PubMed  Google Scholar 

  22. Grosse-Wortmann L, Kreitz S, Grabitz RG, Vazquez-Jimenez JF, Messmer BJ, von Bernuth G, Seghaye MC (2010) Prevalence of and risk factors for perioperative arrhythmias in neonates and children after cardiopulmonary bypass: continuous holter monitoring before and for three days after surgery. J Cardiothorac Surg 5:85

    Article  PubMed  PubMed Central  Google Scholar 

  23. Haas NA, Camphausen CK (2008) Impact of early and standardized treatment with amiodarone on therapeutic success and outcome in pediatric patients with postoperative tachyarrhythmia. J Thorac Cardiovasc Surg 136:1215–1222

    Article  CAS  PubMed  Google Scholar 

  24. Haas NA, Plumpton K, Justo R, Jalali H, Pohlner P (2004) Postoperative junctional ectopic tachycardia (JET). Z Kardiol 93:371–380

    Article  CAS  PubMed  Google Scholar 

  25. Hasegawa T, Oshima Y, Maruo A, Matsuhisa H, Kadowaki T, Noda R (2013) Landiolol for junctional ectopic tachycardia refractory to amiodarone after pediatric cardiac surgery. Gen Thorac Cardiovasc Surg 61:350–352

    Article  PubMed  Google Scholar 

  26. He D, Sznycer-Taub N, Cheng Y, McCarter R, Jonas RA, Hanumanthaiah S, Moak JP (2015) Magnesium lowers the incidence of postoperative junctional ectopic tachycardia in congenital heart surgical patients: is there a relationship to surgical procedure complexity? Pediatr Cardiol 36:1179–1185

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hicks CE, McCord MC, Blount SG Jr (1956) Electrocardiographic changes during hypothermia and circulatory occlusion. Circulation 13:21–28

    Article  CAS  PubMed  Google Scholar 

  28. Hoffman TM, Bush DM, Wernovsky G, Cohen MI, Wieand TS, Gaynor JW, Spray TL, Rhodes LA (2002) Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment. Ann Thorac Surg 74:1607–1611

    Article  PubMed  Google Scholar 

  29. Imamura M, Dossey AM, Garcia X, Shinkawa T, Jaquiss RD (2012) Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair. J Thorac Cardiovasc Surg 143:152–156

    Article  CAS  PubMed  Google Scholar 

  30. Immer FF, Stocker F, Seiler AM, Pfammatter JP, Bachmann D, Printzen G, Carrel T (1999) Troponin-I for prediction of early postoperative course after pediatric cardiac surgery. J Am Coll Cardiol 33:1719–1723

    Article  CAS  PubMed  Google Scholar 

  31. Janousek J, Paul T (1998) Safety of oral propafenone in the treatment of arrhythmias in infants and children (European retrospective multicenter study). Working Group on Pediatric Arrhythmias and Electrophysiology of the Association of European Pediatric Cardiologists. Am J Cardiol 81:1121–1124

    Article  CAS  PubMed  Google Scholar 

  32. Janousek J, Vojtovic P, Chaloupecky V, Hucin B, Tlaskal T, Kostelka M, Reich O (2000) Hemodynamically optimized temporary cardiac pacing after surgery for congenital heart defects. Pacing Clin Electrophysiol 23:1250–1259

    Article  CAS  PubMed  Google Scholar 

  33. Janousek J, Vojtovic P, Gebauer RA (2003) Use of a modified, commercially available temporary pacemaker for R wave synchronized atrial pacing in postoperative junctional ectopic tachycardia. Pacing Clin Electrophysiol 26:579–586

    Article  PubMed  Google Scholar 

  34. Kelly BP, Gajarski RJ, Ohye RG, Charpie JR (2010) Intravenous induction of therapeutic hypothermia in the management of junctional ectopic tachycardia: a pilot study. Pediatr Cardiol 31:11–17

    Article  PubMed  Google Scholar 

  35. Kohli V, Young ML, Perryman RA, Wolff GS (1999) Paired ventricular pacing: an alternative therapy for postoperative junctional ectopic tachycardia in congenital heart disease. Pacing Clin Electrophysiol 22:706–710

    Article  CAS  PubMed  Google Scholar 

  36. Kovacikova L, Hakacova N, Dobos D, Skrak P, Zahorec M (2009) Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia. Ann Thorac Surg 88:616–622

    Article  PubMed  Google Scholar 

  37. Mahmoud AB, Tantawy AE, Kouatli AA, Baslaim GM (2008) Propranolol: a new indication for an old drug in preventing postoperative junctional ectopic tachycardia after surgical repair of tetralogy of Fallot. Interact Cardiovasc Thorac Surg 7:184–187

    Article  PubMed  Google Scholar 

  38. Mandapati R, Byrum CJ, Kavey RE, Smith FC, Kveselis DA, Hannan WP, Brandt B 3rd, Gaum WE (2000) Procainamide for rate control of postsurgical junctional tachycardia. Pediatr Cardiol 21:123–128

    Article  CAS  PubMed  Google Scholar 

  39. Manrique AM, Arroyo M, Lin Y, El Khoudary SR, Colvin E, Lichtenstein S, Chrysostomou C, Orr R, Jooste E, Davis P, Wearden P, Morell V, Munoz R (2010) Magnesium supplementation during cardiopulmonary bypass to prevent junctional ectopic tachycardia after pediatric cardiac surgery: a randomized controlled study. J Thorac Cardiovasc Surg 139(162–169):e162

    Article  Google Scholar 

  40. Matthys D, Verhaaren H, Deryck Y (1995) Fatal pneumonia complicating hypothermia for the treatment of postoperative junctional ectopic tachycardia. Pediatr Cardiol 16:294–296

    Article  CAS  PubMed  Google Scholar 

  41. Mildh L, Hiippala A, Rautiainen P, Pettila V, Sairanen H, Happonen JM (2011) Junctional ectopic tachycardia after surgery for congenital heart disease: incidence, risk factors and outcome. Eur J Cardiothorac Surg 39:75–80

    Article  PubMed  Google Scholar 

  42. Oka H, Sugimoto M, Azuma H (2016) Efficacy of landiolol for the treatment of junctional ectopic tachycardia resulting from sepsis. Cardiol Young 26:183–187

    Article  PubMed  Google Scholar 

  43. Paech C, Dahnert I, Kostelka M, Mende M, Gebauer R (2015) Association of temporary complete AV block and junctional ectopic tachycardia after surgery for congenital heart disease. Ann Pediatr Cardiol 8:14–19

    Article  PubMed  PubMed Central  Google Scholar 

  44. Perry JC, Fenrich AL, Hulse JE, Triedman JK, Friedman RA, Lamberti JJ (1996) Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol. J Am Coll Cardiol 27:1246–1250

    Article  CAS  PubMed  Google Scholar 

  45. Pfammatter JP, Paul T, Ziemer G, Kallfelz HC (1995) Successful management of junctional tachycardia by hypothermia after cardiac operations in infants. Ann Thorac Surg 60:556–560

    Article  CAS  PubMed  Google Scholar 

  46. Raja P, Hawker RE, Chaikitpinyo A, Cooper SG, Lau KC, Nunn GR, Cartmill TB, Sholler GF (1994) Amiodarone management of junctional ectopic tachycardia after cardiac surgery in children. Br Heart J 72:261–265

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Saiki H, Nakagawa R, Ishido H, Masutani S, Senzaki H (2013) Landiolol hydrochloride infusion for treatment of junctional ectopic tachycardia in post-operative paediatric patients with congenital heart defect. Europace 15:1298–1303

    Article  PubMed  Google Scholar 

  48. Sasaki T, Nemoto S, Ozawa H, Katsumata T, Ozaki N, Okumura K, Katayama H, Tamai H, Kishida H (2007) Successful administration of nifekalant hydrochloride for postoperative junctional ectopic tachycardia in congenital cardiac surgery. Kyobu Geka 60:1022–1026

    PubMed  Google Scholar 

  49. Saul JP, Scott WA, Brown S, Marantz P, Acevedo V, Etheridge SP, Perry JC, Triedman JK, Burriss SW, Cargo P, Graepel J, Koskelo EK, Wang R (2005) Intravenous amiodarone for incessant tachyarrhythmias in children: a randomized, double-blind, antiarrhythmic drug trial. Circulation 112:3470–3477

    Article  CAS  PubMed  Google Scholar 

  50. Talwar S, Patel K, Juneja R, Choudhary SK, Airan B (2015) Early postoperative arrhythmias after pediatric cardiac surgery. Asian Cardiovasc Thorac Ann 23:795–801

    Article  PubMed  Google Scholar 

  51. Tharakan JA, Sukulal K (2014) Post cardiac surgery junctional ectopic tachycardia: a ‘Hit and Run’ tachyarrhythmia as yet unchecked. Ann Pediatr Cardiol 7:25–28

    Article  PubMed  PubMed Central  Google Scholar 

  52. Till JA, Rowland E (1991) Atrial pacing as an adjunct to the management of post-surgical His bundle tachycardia. Br Heart J 66:225–229

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Till JA, Ho SY, Rowland E (1992) Histopathological findings in three children with His bundle tachycardia occurring subsequent to cardiac surgery. Eur Heart J 13:709–712

    Article  CAS  PubMed  Google Scholar 

  54. Tobias JD, Chrysostomou C (2013) Dexmedetomidine: antiarrhythmic effects in the pediatric cardiac patient. Pediatr Cardiol 34:779–785

    Article  PubMed  Google Scholar 

  55. Tokunaga C, Hiramatsu Y, Kanemoto S, Takahashi-Igari M, Abe M, Horigome H, Sakakibara Y (2013) Effects of landiolol hydrochloride on intractable tachyarrhythmia after pediatric cardiac surgery. Ann Thorac Surg 95:1685–1688

    Article  PubMed  Google Scholar 

  56. Walsh EP, Saul JP, Sholler GF, Triedman JK, Jonas RA, Mayer JE, Wessel DL (1997) Evaluation of a staged treatment protocol for rapid automatic junctional tachycardia after operation for congenital heart disease. J Am Coll Cardiol 29:1046–1053

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors gratefully thank the representatives of the following participating centers: Heart Center Leipzig, German Heart Center Berlin, University Hospital Hamburg-Eppendorf, University Hospital Schleswig-Holstein Kiel, Links-der-Weser Hospital Bremen, Hannover Medical School, Heart and Diabetes Center Bad Oeynhausen, Justus-Liebig-University Giessen, University of Göttingen, Heart Center Duisburg, Münster University Hospital, University Hospital Cologne, RWTH Aachen University, University Hospital Bonn, Asklepios Children’s Hospital Sankt Augustin, Mainz University Medical Center, Saarland University Medical Center, Heidelberg University Hospital, Olgahospital Stuttgart, University Hospital Tübingen, University Medical Center Freiburg, German Heart Centre Munich, Hospital of the Ludwig-Maximilian-University Munich, University Hospital Erlangen, Germany, Innsbruck Medical University, University Hospital Graz, Kepler University Hospital Linz, Medical University of Vienna, Austria, and University Children’s Hospital Zurich and University Hospital Inselspital Bern, Switzerland.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Andreas Entenmann & Miriam Michel

  2. Department of Pediatric Cardiology, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany

    Ulrike Herberg

  3. Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Ludwig-Maximilian University, Marchioninistrasse 15, 81377, Munich, Germany

    Nikolaus Haas

  4. Department of Pediatric Cardiology, University Children’s Hospital Tübingen, Hoppe-Seyler-Strasse 1, 72076, Tübingen, Germany

    Matthias Kumpf

  5. Department of Pediatric Cardiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Matthias Gass

  6. Department for Congenital Heart Disease and Pediatric Cardiology, Schleswig-Holstein University Hospital, Arnold-Heller-Strasse 3, 24105, Kiel, Germany

    Friedemann Egender

  7. Department of Pediatric Cardiology, University of Leipzig, Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany

    Roman Gebauer

Authors
  1. Andreas Entenmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miriam Michel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulrike Herberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nikolaus Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthias Kumpf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthias Gass
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Friedemann Egender
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Roman Gebauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AE and MM designed the study. AE developed the questionnaire. AE, MM, FE, MG, UH, NH, and MK participated in data acquisition and analysis. AE wrote the manuscript. RG, NH, UH, and MM helped with data interpretation and reviewed the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Andreas Entenmann.

Ethics declarations

Funding

There was no funding applied to complete this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individuals participated in this study.

Additional information

Communicated by Jaan Toelen

Electronic supplementary material

Online file 1

Questionnaire used in the study (German) (PDF 66 kb)

Online file 2

Questionnaire used in the study (English) (PDF 64 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Entenmann, A., Michel, M., Herberg, U. et al. Management of postoperative junctional ectopic tachycardia in pediatric patients: a survey of 30 centers in Germany, Austria, and Switzerland. Eur J Pediatr 176, 1217–1226 (2017). https://doi.org/10.1007/s00431-017-2969-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-017-2969-x

Keywords

Search

Navigation