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Ann Thorac Surg 2009;88:616-622. doi:10.1016/j.athoracsur.2009.04.088
© 2009 The Society of Thoracic Surgeons
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Original Articles: Pediatric Cardiac

Amiodarone as a First-Line Therapy for Postoperative Junctional Ectopic Tachycardia

Lubica Kovacikova, MD, PhD*, Nina Hakacova, MD, Dusan Dobos, MD, Peter Skrak, MD, PhD, Martin Zahorec, MD

Intensive Care Unit, Children's Cardiac Center, Bratislava, Slovakia

Accepted for publication April 24, 2009.

* Address correspondence to Dr Kovacikova, Children's Cardiac Center, Limbova 1, Bratislava, 833 51, Slovakia (Email: lkovacikova{at}yahoo.com).

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 µg/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.


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Invited commentary.

Ann. Thorac. Surg. 88: 622-623. [Full Text]



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Invited commentary.
Ann. Thorac. Surg., August 1, 2009; 88(2): 622 - 623.
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