POSTOPERATIVE JUNCTIONAL ECTOPIC TACHYCARDIA

Authors
Citation
Fj. Azzam et Ac. Fiore, POSTOPERATIVE JUNCTIONAL ECTOPIC TACHYCARDIA, Canadian journal of anaesthesia, 45(9), 1998, pp. 898-902
Citations number
16
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Anesthesiology
ISSN journal
0832-610X
Volume
45
Issue
9
Year of publication
1998
Pages
898 - 902
Database
ISI
SICI code
0832-610X(1998)45:9<898:PJET>2.0.ZU;2-0
Abstract
Purpose: To report the management of junctional ectopic tachycardia af ter cardiac surgery in an infant. Postoperatively, the patient suffere d profound cardiac decompensation secondary to the accelerated rhythm and required extracorporeal membrane oxygenation (ECMO) for haemodynam ic support. Clinical features: A 14-day-old, 3.5 kg boy exhibited junc tional ectopic tachycardia after cardiopulmonary bypass. Left atrial p ressure was 25-28 mmHg. No impact on the tachycardia was seen after ra pid overdrive atrial pacing or after 20 mu g fentanyl iv, 45 mu g digi talis, 100 mg magnesium or procainamide (loading dose 15 mg, then 30 m g.k(-1).min(-1)). Active cooling decreased the nasopharyngeal temperat ure to 35.2 degrees C, when the heart rate decreased below 180 bpm wit h a left atrial pressure of 8-10 mmHg. Dopamine (2 mu g.kg(-1).min(-1) ) and dobutamine (5 mu g.k(-1).min(-1)) were added to improve the card iac output, Sodium nitroprusside (0.25 to 1 mu g.k(-1).min) maintained the systolic pressure < 100 mmHg. On arrival in ICU, heart rate incre ased to 200 bpm. The patient received cardiac massage for severe hypot ension 75 min after surgery. Emergency ECMO was instituted for circula tory support. Procainamide, digoxin, dopamine, dobutamine, sodium nitr oprusside and hypothermia were continued. Sinus rhythm resumed on the first postoperative day, but procainamide and induced hypothermia at 3 4 degrees C were maintained for 36 hr after normalization of the rhyth m to prevent recurrence of the tachycardia, Total duration of ECMO was three and a half days, Recovery was uneventful. Conclusion: The use o f ECMO, as a first line of defence, is suitable for the emergency supp ort of patients with JET because of the ease of support of circulation and precise control of hypothermia.