Epidemiology of Postoperative Junctional Ectopic Tachycardia in Infants Undergoing Cardiac Surgery.

BACKGROUND: Junctional ectopic tachycardia (JET) complicates congenital heart surgery in 2-8.3% of cases. JET is associated with postoperative morbidity in single-center studies. We utilized the Pediatric Cardiac Critical Care Consortium data registry for the first multicenter epidemiologic description of treated JET.

METHODS: This is a retrospective study (2/2019 - 8/2022) of patients with treated JET.

INCLUSION: 1) <12 months old at index operation; 2) treated for JET <72 hours after surgery. Diagnosis defined by receiving treatment (pacing, cooling, medications). A multilevel logistic regression analysis with hospital random effect identified JET risk factors. Impact of JET on outcomes was estimated via margins/attributable risk analysis using previous risk-adjustment models.

RESULTS: 1436/24,073 (6.0%) patients from 63 centers were treated for JET with significant center variability (0% - 17.9%). Median time to onset was 3.4 hours with 34% present on admission. Median duration was 2 (IQR 1, 4) days. Tetralogy of Fallot (TOF), atrioventricular canal, and ventricular septal defect (VSD) repair represented >50% of JET. Patient characteristics independently associated with JET included neonatal age, Asian race, cardiopulmonary bypass time, open sternum, and early postoperative inotropes. JET was associated with increased risk-adjusted durations of mechanical ventilation (IRR 1.6, 95% CI 1.5-1.7) and ICU length of stay (IRR 1.3, 95% CI 1.2-1.3), but not mortality.

CONCLUSIONS: JET is treated in 6% of patients with substantial center variability. JET contributes to increased postoperative resource utilization. High center variability warrants further study to identify potential modifiable factors which could serve as targets for improvement efforts to ameliorate deleterious outcomes.