AMIODARONE MANAGEMENT OF JUNCTIONAL ECTOPIC TACHYCARDIA AFTER CARDIAC-SURGERY IN CHILDREN

Objective-To assess the effectiveness and safety of amiodarone in the treatment of junctional ectopic tachycardia (JET) after open heart sur gery in children. Patients-Between January 1990 and December 1991, 16 consecutive patients aged 6 days to 14 years with JET associated with significant haemodynamic impairment after cardiopulmonary bypass were treated with amiodarone as the principal antiarrhythmic drug. Interven tions-Amiodarone 5 mg/kg was administered intravenously over one hour and the same dose was subsequently infused over 12 hours. This was rev iewed every 12 hours and repeated as necessary until a satisfactory he art rate and stable haemodynamics were achieved. Atrial pacing was use d whenever possible to provide atrioventricular synchrony. Results-Exc ept for one patient with a JET rate of 160/min, the maximum JET rate r anged from 180/min to 245/min with a mean(SD) of 200 (20)/min. After a miodarone, the heart rates reduced to a mean(SD) of 170 (20), 164 (27) , 158 (27), 157 (24), and 153 (19)/min at two, four, eight, 12, and 24 hours respectively. A reduction in tachycardia rate allowing atrial p acing was achieved in 10 patients by two hours. Haemodynamic variables improved in most patients with an increase in mean systolic blood pre ssure by an average of 15 mm Hg and a decrease in atrial filling press ures by an average of 3.5 mm Hg at four hours after amiodarone adminis tration. There were three deaths: one was a moribund patient who died soon after the onset of JET and the other two deaths were not directly related to JET. Complications-Late bradycardia with hypotension was r ecorded in one patient. Asymptomatic late sinus bradycardia was seen i n several others. Conclusions-Amiodarone can be used safely and effect ively to control JET with haemodynamic improvement in most patients. T he addition of atrial pacing confers the advantage of atrioventricular synchrony.