Pediatric Nonpost-Operative Junctional Ectopic Tachycardia. Medical Management and Interventional Therapies

Kathryn K. Collins, George F. Van Hare, Naomi J. Kertesz, Ian H. Law, Yaniv Bar-Cohen, Anne M. Dubin, Susan P. Etheridge, Charles I. Berul, Jennifer N. Avari, Volkan Tuzcu, Narayanswami Sreeram, Michael S. Schaffer, Anne Fournier, Shubhayan Sanatani, Christopher S. Snyder, Richard T. Smith, Luis Arabia, Robert Hamilton, Terrence Chun, Leonardo LibermanBahram Kakavand, Thomas Paul, Ronn E. Tanel

Research output: Contribution to journalArticle

86 Scopus citations

Abstract

Objectives: To determine the outcomes of medical management, pacing, and catheter ablation for the treatment of nonpost-operative junctional ectopic tachycardia (JET) in a pediatric population. Background: Nonpost-operative JET is a rare tachyarrhythmia that is associated with a high rate of morbidity and mortality. Most reports of clinical outcomes were published before the routine use of amiodarone or ablation therapies. Methods: This is an international, multicenter retrospective outcome study of pediatric patients treated for nonpost-operative JET. Results: A total of 94 patients with JET and 5 patients with accelerated junctional rhythm (age 0.8 year, range fetus to 16 years) from 22 institutions were identified. JET patients presenting at age ≤6 months were more likely to have incessant JET and to have faster JET rates. Antiarrhythmic medications were utilized in a majority of JET patients (89%), and of those, amiodarone was the most commonly reported effective agent (60%). Radiofrequency ablation was conducted in 17 patients and cryoablation in 27, with comparable success rates (82% radiofrequency vs. 85% cryoablation, p = 1.0). Atrioventricular junction ablation was required in 3% and pacemaker implantation in 14%. There were 4 (4%) deaths, all in patients presenting at age ≤6 months. Conclusions: Patients with nonpost-operative JET have a wide range of clinical presentations, with younger patients demonstrating higher morbidity and mortality. With current medical, ablative, and device therapies, the majority of patients have a good clinical outcome.

Original languageEnglish
Pages (from-to)690-697
Number of pages8
JournalJournal of the American College of Cardiology
Volume53
Issue number8
DOIs
StatePublished - Feb 24 2009

Keywords

  • amiodarone
  • arrhythmia
  • child
  • cryoablation
  • junctional ectopic tachycardia
  • radiofrequency catheter ablation

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    Collins, K. K., Van Hare, G. F., Kertesz, N. J., Law, I. H., Bar-Cohen, Y., Dubin, A. M., Etheridge, S. P., Berul, C. I., Avari, J. N., Tuzcu, V., Sreeram, N., Schaffer, M. S., Fournier, A., Sanatani, S., Snyder, C. S., Smith, R. T., Arabia, L., Hamilton, R., Chun, T., ... Tanel, R. E. (2009). Pediatric Nonpost-Operative Junctional Ectopic Tachycardia. Medical Management and Interventional Therapies. Journal of the American College of Cardiology, 53(8), 690-697. https://doi.org/10.1016/j.jacc.2008.11.019