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Current Cardiology Reviews

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ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

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Systematic Review Article

A Comparative Effectiveness Systematic Review and Meta-analysis of Drugs for the Prophylaxis of Junctional Ectopic Tachycardia

Author(s): Brian Mendel*, Christianto Christianto, Moira Setiawan, Radityo Prakoso and Sisca Natalia Siagian

Volume 18, Issue 1, 2022

Published on: 03 June, 2021

Article ID: e030621193817 Pages: 11

DOI: 10.2174/1573403X17666210603113430

Price: $65

Abstract

Background: Junctional Ectopic Tachycardia (JET) is an arrhythmia originating from the AV junction, which may occur following congenital heart surgery, especially when the intervention is near the atrioventricular junction.

Objective: The aim of this systematic review and meta-analysis is to compare the effectiveness of amiodarone, dexmedetomidine, and magnesium in preventing JET following congenital heart surgery.

Methods: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, where 11 electronic databases were searched from the date of inception to August 2020. The incidence of JET was calculated with the relative risk of 95% Confidence Interval (CI). Quality assessment of the included studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.

Results: Eleven studies met the predetermined inclusion criteria and were included in this meta-analysis. Amiodarone, dexmedetomidine, and magnesium significantly reduced the incidence of postoperative JET [Amiodarone: risk ratio 0.34; I2= 0%; Z=3.66 (P=0.0002); 95% CI 0.19-0.60. Dexmedetomidine: risk ratio 0.34; I2= 0%; Z=4.77 (P<0.00001); 95% CI 0.21-0.52. Magnesium: risk ratio 0.50; I2= 24%; Z=5.08 (P<0.00001); 95% CI 0.39-0.66].

Conclusion: All three drugs have shown promising results in reducing the incidence of JET. Our systematic review found that dexmedetomidine is better in reducing the length of ICU stays as well as mortality. In addition, dexmedetomidine also has the least pronounced side effects among the three. However, it should be noted that this conclusion was derived from studies with small sample sizes. Therefore, dexmedetomidine may be considered as the drug of choice for preventing JET.

Keywords: Amiodarone, congenital heart surgery, dexmedetomidine, junctional ectopic tachycardia, magnesium, prophylaxis.

Graphical Abstract

[1]
Abdelaziz O, Deraz S. Anticipation and management of junctional ectopic tachycardia in postoperative cardiac surgery: Single center experience with high incidence. Ann Pediatr Cardiol 2014; 7(1): 19-24.
[http://dx.doi.org/10.4103/0974-2069.126543] [PMID: 24701080]
[2]
Mildh L, Hiippala A, Rautiainen P, Pettilä V, Sairanen H, Happonen JM. Junctional ectopic tachycardia after surgery for congenital heart disease: Incidence, risk factors and outcome. Eur J Cardiothorac Surg 2011; 39(1): 75-80.
[http://dx.doi.org/10.1016/j.ejcts.2010.04.002] [PMID: 20537549]
[3]
Chelo D, Ateba NA, Tchoumi JCT, et al. Early postoperative arrhythmias after cardiac surgery in children at the shisong cardiac center, Cameroon. Delta Med Col J 2018; 6(1): 22-8.
[http://dx.doi.org/10.3329/dmcj.v6i1.35964]
[4]
Dodge-Khatami A, Miller OI, Anderson RH, et al. Surgical substrates of postoperative junctional ectopic tachycardia in congenital heart defects. J Thorac Cardiovasc Surg 2002; 123(4): 624-30.
[http://dx.doi.org/10.1067/mtc.2002.121046] [PMID: 11986588]
[5]
Pfammatter J-P, Bachmann DCG, Wagner BP, et al. Early postoperative arrhythmias after open-heart procedures in children with congenital heart disease. Pediatr Crit Care Med 2001; 2(3): 217-22.
[http://dx.doi.org/10.1097/00130478-200107000-00005] [PMID: 12793944]
[6]
Yildirim SV, Tokel K, Saygili B, Varan B. The incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients. Turk J Pediatr 2008; 50(6): 549-53.
[PMID: 19227418]
[7]
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6(7): e1000097.
[http://dx.doi.org/10.1371/journal.pmed.1000097] [PMID: 19621072]
[8]
Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. BMJ 2010.
[9]
Manager R. Version 54, The Cochrane Collaboration 2020.
[10]
Rajput RS, Das S, Makhija N, Airan B. Efficacy of dexmedetomidine for the control of junctional ectopic tachycardia after repair of tetralogy of Fallot. Ann Pediatr Cardiol 2014; 7(3): 167-72.
[http://dx.doi.org/10.4103/0974-2069.140826] [PMID: 25298690]
[11]
Dorman BH, Sade RM, Burnette JS, et al. Magnesium supplementation in the prevention of arrhythmias in pediatric patients undergoing surgery for congenital heart defects. Am Heart J 2000; 139(3): 522-8.
[http://dx.doi.org/10.1016/S0002-8703(00)90097-8] [PMID: 10689268]
[12]
Amrousy DE, Elshehaby W, Feky WE, Elshmaa NS. Safety and efficacy of prophylactic amiodarone in preventing early Junctional Ectopic Tachycardia (JET) in children after cardiac surgery and determination of its risk factor. Pediatr Cardiol 2016; 37(4): 734-9.
[http://dx.doi.org/10.1007/s00246-016-1343-5] [PMID: 26818850]
[13]
Jadon M, Kynta RL, Thingnam SKS. Effectiveness of oral amiodarone in prevention of perioperative junctional ectopic tachycardia in patients of tetralogy of fallot undergoing intracardiac repair. Int J Sci Res (Ahmedabad) 2019; 8(10): 81-3.
[14]
Imamura M, Dossey AM, Garcia X, Shinkawa T, Jaquiss RD. Prophylactic amiodarone reduces junctional ectopic tachycardia after tetralogy of Fallot repair. J Thorac Cardiovasc Surg 2012; 143(1): 152-6.
[http://dx.doi.org/10.1016/j.jtcvs.2011.09.042] [PMID: 22035965]
[15]
El Amrousy DM, Elshmaa NS, El-Kashlan M, et al. Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia after pediatric cardiac surgery. J Am Heart Assoc 2017; 6(3): e004780.
[http://dx.doi.org/10.1161/JAHA.116.004780] [PMID: 28249845]
[16]
Gautam NK, Turiy Y, Srinivasan C. Preincision initiation of dexmedetomidine maximally reduces the risk of junctional ectopic tachycardia in children undergoing ventricular septal defect repairs. J Cardiothorac Vasc Anesth 2017; 31(6): 1960-5.
[http://dx.doi.org/10.1053/j.jvca.2017.04.010] [PMID: 28774644]
[17]
Kadam SV, Tailor KB, Kulkarni S, Mohanty SR, Joshi PV, Rao SG. Effect of dexmeditomidine on postoperative junctional ectopic tachycardia after complete surgical repair of tetralogy of Fallot: A prospective randomized controlled study. Ann Card Anaesth 2015; 18(3): 323-8.
[http://dx.doi.org/10.4103/0971-9784.159801] [PMID: 26139736]
[18]
He D, Sznycer-Taub N, Cheng Y, et al. Magnesium lowers the incidence of postoperative junctional ectopic tachycardia in congenital heart surgical patients: Is there a relationship to surgical procedure complexity? Pediatr Cardiol 2015; 36(6): 1179-85.
[http://dx.doi.org/10.1007/s00246-015-1141-5] [PMID: 25762470]
[19]
He D, Aggarwal N, Zurakowski D, et al. Lower risk of postoperative arrhythmias in congenital heart surgery following intraoperative administration of magnesium. J Thorac Cardiovasc Surg 2018; 156(2): 763-770.e1.
[http://dx.doi.org/10.1016/j.jtcvs.2018.04.044] [PMID: 29778339]
[20]
Manrique AM, Arroyo M, Lin Y, et al. Magnesium supplementation during cardiopulmonary bypass to prevent junctional ectopic tachycardia after pediatric cardiac surgery: A randomized controlled study. J Thorac Cardiovasc Surg 2010; 139(1): 162-169.e2.
[http://dx.doi.org/10.1016/j.jtcvs.2009.07.064] [PMID: 19819469]
[21]
Rekawek J, Kansy A, Miszczak-Knecht M, et al. Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period. J Thorac Cardiovasc Surg 2007; 133(4): 900-4.
[http://dx.doi.org/10.1016/j.jtcvs.2006.12.011] [PMID: 17382623]
[22]
Kylat RI, Samson RA. Junctional ectopic tachycardia in infants and children. J Arrhythm 2019; 36(1): 59-66.
[http://dx.doi.org/10.1002/joa3.12282] [PMID: 32071621]
[23]
Alasti M, Mirzaee S, Machado C, et al. Junctional ectopic tachycardia (JET). J Arrhythm 2020; 36(5): 837-44.
[http://dx.doi.org/10.1002/joa3.12410] [PMID: 33024461]
[24]
Batra AS, Mohari N. Junctional ectopic tachycardia: Current strategies for diagnosis and management. Prog Pediatr Cardiol 2013; 35: 49-54.
[http://dx.doi.org/10.1016/j.ppedcard.2012.11.007]
[25]
Vassallo P, Trohman RG. Prescribing amiodarone: An evidence-based review of clinical indications. JAMA 2007; 298(11): 1312-22.
[http://dx.doi.org/10.1001/jama.298.11.1312] [PMID: 17878423]
[26]
Epstein AE, Olshansky B, Naccarelli GV, Kennedy JI Jr, Murphy EJ, Goldschlager N. Practical management guide for clinicians who treat patients with amiodarone. Am J Med 2016; 129(5): 468-75.
[http://dx.doi.org/10.1016/j.amjmed.2015.08.039] [PMID: 26497904]
[27]
Florek JB, Girzadas D. Amiodarone.StatPearls. Treasure Island, FL: StatPearls Publishing 2020. updated 2020 Aug 23 Internet Available from: https://www.ncbi.nlm.nih.gov/books/NBK482154/
[28]
Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet 2017; 56(8): 893-913.
[http://dx.doi.org/10.1007/s40262-017-0507-7] [PMID: 28105598]
[29]
Cools E, Missant C. Junctional ectopic tachycardia after congenital heart surgery. Acta Anaesthesiol Belg 2014; 65(1): 1-8.
[PMID: 24988822]
[30]
Cieslewicz A, Jankowski J, Korzeniowska K, et al. The role of magnesium in cardiac arrhythmias. J Elem 2012; 18(2): 317-27.
[http://dx.doi.org/10.5601/jelem.2013.18.2.11]

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