CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Azzam, F. J.
Right arrow Articles by Fiore, A. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Azzam, F. J.
Right arrow Articles by Fiore, A. C.

Canadian Journal of Anesthesia, Vol 45, 898-902, Copyright © 1998 by Canadian Anesthesiologists' Society

ARTICLES

Postoperative junctional ectopic tachycardia

FJ Azzam and AC Fiore
Department of Anesthesiology, Saint Louis University Medical Center, MO 63110, USA.

PURPOSE: To report the management of junctional ectopic tachycardia after cardiac surgery in an infant. Postoperatively, the patient suffered profound cardiac decompensation secondary to the accelerated rhythm and required extracorporeal membrane oxygenation (ECMO) for haemodynamic support. CLINICAL FEATURES: A 14-day-old, 3.5 kg boy exhibited junctional ectopic tachycardia after cardiopulmonary bypass. Left atrial pressure was 25-28 mmHg. No impact on the tachycardia was seen after rapid overdrive atrial pacing or after 20 micrograms fentanyl i.v., 45 micrograms digitalis, 100 mg magnesium or procainamide (loading dose 15 mg, then 30 mg.kg-1.min-1). Active cooling decreased the nasopharyngeal temperature to 35.2 degrees C, when the heart rate decreased below 180 bpm with a left atrial pressure of 8-10 mmHg. Dopamine (2 micrograms.kg-1.min-1) and dobutamine (5 micrograms.kg-1.min-1) were added to improve the cardiac output. Sodium nitroprusside (0.25 to 1 microgram.kg-1.min) maintained the systolic pressure < 100 mmHg. On arrival in ICU, heart rate increased to 200 bpm. The patient received cardiac massage for severe hypotension 75 min after surgery. Emergency ECMO was instituted for circulatory support. Procainamide, digoxin, dopamine, dobutamine, sodium nitroprusside and hypothermia were continued. Sinus rhythm resumed on the first postoperative day, but procainamide and induced hypothermia at 34 degrees C were maintained for 36 hr after normalization of the rhythm to prevent recurrence of the tachycardia. Total duration of ECMO was three and a half days. Recovery was uneventful. CONCLUSION: The use of ECMO, as a first line of defence, is suitable for the emergency support of patients with JET because of the ease of support of circulation and precise control of hypothermia.


This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Tajik and M. G. Cardarelli
Extracorporeal membrane oxygenation after cardiac arrest in children: what do we know?
Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 409 - 417.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
A. Dodge-Khatami, O.I. Miller, R.H. Anderson, J.M. Gil-Jaurena, A.P. Goldman, and M.R. de Leval
Impact of junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects
Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 255 - 259.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
M. Botero and L. K. Davies
Diagnosis and Management of Arrhythmias in Children After Cardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2001; 5(1): 122 - 133.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1998 by the Canadian Anesthesiologists' Society.