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Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia.
Ann Thorac Surg 2009; 88(2):616-22AT

Abstract

BACKGROUND

Postoperative junctional ectopic tachycardia is a potentially life-threatening arrhythmia that is often resistant to conventional antiarrhythmic drugs. Amiodarone was suggested to be an adequate treatment; however, data regarding its efficacy and safety are limited. This study evaluated the efficacy of amiodarone in the first-line treatment of postoperative junctional ectopic tachycardia and assessed factors associated with failure of amiodarone therapy.

METHODS

The study included 40 pediatric cardiosurgical patients with postoperative junctional ectopic tachycardia. Intravenous amiodarone in 2-mg/kg boluses and, if necessary, as continuous infusion (10 to 15 mug/kg/min), were used as the first-line therapy. Restoration of sinus rhythm or slowing of junctional ectopic tachycardia to a rate that allowed atrial or atrioventricular sequential pacing was considered as efficacy of therapy.

RESULTS

Amiodarone was effective in 18 patients (45%). Sinus rhythm was achieved in 7, and heart rate decreased in 11 patients from 180 (range, 173 to 200) to 142 (range, 133-155) beats/min (p < 0.0001) and allowed effective pacing with atrioventricular synchrony. Higher arteriovenous oxygen saturation difference (p = 0.007) and lower body temperature (p = 0.02) were associated with failure of amiodarone therapy.

CONCLUSIONS

Amiodarone as the first-line treatment was effective in almost half of the patients with postoperative junctional ectopic tachycardia. Higher arteriovenous oxygen saturation difference and lower body temperature were associated with failure of amiodarone therapy, and their presence may suggest more aggressive initial approach consisting of amiodarone combined with hypothermia.

Authors+Show Affiliations

Intensive Care Unit, Children's Cardiac Center, Bratislava, Slovakia. lkovacikova@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19632422

Citation

Kovacikova, Lubica, et al. "Amiodarone as a First-line Therapy for Postoperative Junctional Ectopic Tachycardia." The Annals of Thoracic Surgery, vol. 88, no. 2, 2009, pp. 616-22.
Kovacikova L, Hakacova N, Dobos D, et al. Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia. Ann Thorac Surg. 2009;88(2):616-22.
Kovacikova, L., Hakacova, N., Dobos, D., Skrak, P., & Zahorec, M. (2009). Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia. The Annals of Thoracic Surgery, 88(2), pp. 616-22. doi:10.1016/j.athoracsur.2009.04.088.
Kovacikova L, et al. Amiodarone as a First-line Therapy for Postoperative Junctional Ectopic Tachycardia. Ann Thorac Surg. 2009;88(2):616-22. PubMed PMID: 19632422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia. AU - Kovacikova,Lubica, AU - Hakacova,Nina, AU - Dobos,Dusan, AU - Skrak,Peter, AU - Zahorec,Martin, PY - 2009/01/30/received PY - 2009/04/21/revised PY - 2009/04/24/accepted PY - 2009/7/28/entrez PY - 2009/7/28/pubmed PY - 2009/8/22/medline SP - 616 EP - 22 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 88 IS - 2 N2 - BACKGROUND: Postoperative junctional ectopic tachycardia is a potentially life-threatening arrhythmia that is often resistant to conventional antiarrhythmic drugs. Amiodarone was suggested to be an adequate treatment; however, data regarding its efficacy and safety are limited. This study evaluated the efficacy of amiodarone in the first-line treatment of postoperative junctional ectopic tachycardia and assessed factors associated with failure of amiodarone therapy. METHODS: The study included 40 pediatric cardiosurgical patients with postoperative junctional ectopic tachycardia. Intravenous amiodarone in 2-mg/kg boluses and, if necessary, as continuous infusion (10 to 15 mug/kg/min), were used as the first-line therapy. Restoration of sinus rhythm or slowing of junctional ectopic tachycardia to a rate that allowed atrial or atrioventricular sequential pacing was considered as efficacy of therapy. RESULTS: Amiodarone was effective in 18 patients (45%). Sinus rhythm was achieved in 7, and heart rate decreased in 11 patients from 180 (range, 173 to 200) to 142 (range, 133-155) beats/min (p < 0.0001) and allowed effective pacing with atrioventricular synchrony. Higher arteriovenous oxygen saturation difference (p = 0.007) and lower body temperature (p = 0.02) were associated with failure of amiodarone therapy. CONCLUSIONS: Amiodarone as the first-line treatment was effective in almost half of the patients with postoperative junctional ectopic tachycardia. Higher arteriovenous oxygen saturation difference and lower body temperature were associated with failure of amiodarone therapy, and their presence may suggest more aggressive initial approach consisting of amiodarone combined with hypothermia. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/19632422/Amiodarone_as_a_first_line_therapy_for_postoperative_junctional_ectopic_tachycardia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)00824-8 DB - PRIME DP - Unbound Medicine ER -