To Study Effective Dosage of Intravenous Amiodarone to Prevent Junctional Ectopic Tachycardia After Paediatric Cardiac Surgery

Shabahat Ali Siddiqui, Kangkan Sharma, Amit Sabharwal
Author(s)
1Consultant Adult and Paediatric Cardiac Anesthesia, Department of Cardiothoracic and Vascular Surgery, Apollo Hospital, Global Square, Patan Road, Karmeta, Jabalpur, Madhya Pradesh, India. 2Senior Consultant Cardiac Anaesthesiology. Department of Cardiac Anaesthesiology, Health City HospitalNH-37, Koinadhara, Khanapara, Uday Nagar (Opposite Bodoland Guest House), Guwahati, Assam, India. 3Specialist Anesthesiologist, Department of Anesthesiologist and critical care, Global Medical Solutions Hospital Management LLC CCCJ+493, Arabian Gulf Street, Al Rawdah, Abu Dhabi – United Arab Emirates.

Abstract

Background: Junctional ectopic tachycardia (JET) is a frequent postoperative arrhythmia after paediatric congenital heart surgery, contributing to haemodynamic instability and prolonged hospital stay. Prophylactic strategies are limited; recent pharmacologic interest has focused on amiodarone, but its intra operative role during cardiopulmonary bypass (CPB) is not well defined. The aim of the study was to evaluate the effectiveness of intraoperative amiodarone supplementation during cardiopulmonary bypass in reducing the incidence and severity of junctional ectopic tachycardia (JET) after paediatric cardiac surgery. Material and Methods: Prospective, randomized controlled trial. Department of paediatric cardiac anesthesia, shri Sathya sai sanjeevani hospital Naya Raipur. 1 year duration, 100 paediatric patients undergoing cardiac surgery under cardiopulmonary bypass were enrolled in the study. Results: Intraoperative amiodarone significantly reduced the incidence of postoperative JET (8% vs. 30%, P=0.004) and sustained JET >1 hour (2% vs. 18%, P=0.01). It also lowered postoperative amiodarone bolus infusion (2% vs. 20%, P=0.005) and reduced heart rate (118 ± 12 vs. 132 ± 15 bpm, P<0.001) and VIS score (6 ± 3 vs. 9 ± 4, P=0.001). ICU (2 vs. 3 days, P=0.02) and hospital stays (7 vs. 9 days, P=0.01) were shorter. Multivariate analysis confirmed amiodarone as an independent protective factor against JET (aOR 5.6, P=0.004). Conclusion: Intraoperative Intravenous amiodarone is a safe and effective strategy to prevent postoperative JET in paediatric cardiac surgery. It significantly reduces JET incidence and postoperative amiodarone use. Improved haemodynamics, shorter ICU stay, and reduced hospital duration were observed. These findings support its routine prophylactic use.

Keywords: Junctional ectopic tachycardia; amiodarone; cardiopulmonary bypass; paediatric cardiac surgery; prophylaxis; arrhythmia prevention.

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