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Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair.

AbstractOBJECTIVE:
Junctional ectopic tachycardia is common after pediatric heart surgery. After tetralogy of Fallot repair, the incidence of junctional ectopic tachycardia may be as high as 15% to 20%. We introduced prophylactic amiodarone for tetralogy repair. This study was conducted to evaluate the effectiveness of the prophylactic amiodarone.
METHODS:
A continuous infusion of amiodarone was started in the operating room at the time of rewarming during cardiopulmonary bypass at a rate of 2 mg/kg/d and continued for 48 hours. Between November 2005 and November 2009, 63 consecutive patients underwent primary repair of tetralogy, of whom 20 had prophylactic amiodarone (amiodarone group) and 43 did not (control group). Variables studied included demographic and bypass data, surgical procedure details (transannular or nontransannular patch), preoperative and postoperative echocardiography findings, and postoperative inotropic support. Univariate and stepwise multivariate analyses were conducted to determine factors associated with the occurrence of junctional ectopic tachycardia.
RESULTS:
The incidence of junctional ectopic tachycardia was 37% in the control group and 10% in the amiodarone group. The groups were similar in age, weight, bypass time, rate of transannular patch usage, and preoperative and postoperative gradient through the right ventricular outflow tract. Prophylactic amiodarone was significantly negatively associated with junctional ectopic tachycardia by both univariate (P = .039) and multivariate (P = .027) analyses. There were no adverse events attributable to prophylactic amiodarone use.
CONCLUSIONS:
Prophylactic amiodarone is well tolerated and significantly associated with a decreased incidence of junctional ectopic tachycardia after tetralogy repair.
AuthorsMichiaki Imamura, Amy M Dossey, Xiomara Garcia, Takeshi Shinkawa, Robert D B Jaquiss
JournalThe Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 143 Issue 1 Pg. 152-6 (Jan 2012) ISSN: 1097-685X [Electronic] United States
PMID22035965 (Publication Type: Journal Article)
CopyrightCopyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Chemical References
  • Anti-Arrhythmia Agents
  • Amiodarone
Topics
  • Amiodarone (therapeutic use)
  • Anti-Arrhythmia Agents (therapeutic use)
  • Child, Preschool
  • Humans
  • Postoperative Complications (etiology, prevention & control)
  • Retrospective Studies
  • Tachycardia, Ectopic Junctional (etiology, prevention & control)
  • Tetralogy of Fallot (surgery)

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