Abstract:
Background
Accelerated junctional rhythm (AJR) and Junctional ectopic tachycardia (JET) are common
post-operative arrhythmias associated with morbidity/mortality. Studies suggest that
pre- or intra-operative treatment may improve outcomes, but patient selection remains
a challenge.
Objectives
Our objective was to describe contemporary outcomes of post-operative AJR/JET and
develop a risk-prediction score to identify patients at highest risk.
Methods
Retrospective cohort study of children 0-18 years undergoing cardiac surgery (2011-2018).
AJR was defined as usual complex tachycardia with ≥1:1 ventricular-atrial association
and junctional rate >25th percentile of sinus rate for age but < 170 bpm while JET was defined as a rate >170
bpm. A risk prediction score was developed using random forest analysis and logistic
regression.
Results
From 6364 surgeries, AJR occurred in 215 (3.4%) and JET in 59 (0.9%). Age, heterotaxy
syndrome, aortic cross-clamp time, ventricular septal defect closure and atrio-ventricular
canal repair were independent predictors of AJR/JET on multivariate analysis and included
in the risk prediction score. The model accurately predicted the risk of AJR/JET with
a C-index of 0.72 [95% CI 0.70, 0.75]. Post-operative AJR and JET was associated with
prolonged ICU and hospital length of stay, but not with early mortality.
Conclusion
We describe a novel risk prediction score to estimate the risk of post-operative AJR/JET
permitting early identification of at-risk patients who may benefit from prophylactic
treatment.
Keywords
Abbreviations:
CHD (Congenital heart disease), AJR (Accelerated junctional rhythm), JET (Junctional ectopic tachycardia), CPB (Cardio-pulmonary bypass), ECMO (Extracorporeal membrane oxygenation), VSD (Ventricular septal defect), AVC (Atrioventricular canal), TOF (Tetralogy of Fallot), CC (Cross-clamp)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
March 3,
2023
Received in revised form:
February 27,
2023
Received:
December 21,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethics approval statement: The institutional review board approved this study.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
