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CLINICAL RESEARCH: HEART RHYTHM DISORDERS IN CHILDREN

Pediatric Nonpost-Operative Junctional Ectopic Tachycardia

Medical Management and Interventional Therapies

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

^_* Departments of Pediatrics, Divisions of Cardiology, The Children's Hospital, Denver, Colorado
Departments of Pediatrics, Divisions of Cardiology, University of California, San Francisco, California
Departments of Pediatrics, Divisions of Cardiology, Stanford University, Palo Alto, California
Departments of Pediatrics, Divisions of Cardiology, Texas Children's Hospital, Houston, Texas
^|| Departments of Pediatrics, Divisions of Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa
^¶ Departments of Pediatrics, Divisions of Cardiology, Children's Hospital, Los Angeles, California
^# Departments of Pediatrics, Divisions of Cardiology, Primary Children's Hospital, Salt Lake City, Utah
^_** Departments of Pediatrics, Divisions of Cardiology, Children's Hospital, Boston, Massachusetts
Departments of Pediatrics, Divisions of Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
Departments of Pediatrics, Divisions of Cardiology, Arkansas Children's Hospital, Little Rock, Arkansas
Departments of Pediatrics, Divisions of Cardiology, University Hospital of Cologne, Koln, Germany
^|||| Departments of Pediatrics, Divisions of Cardiology, Hospital Sainte-Justine, Montreal, Quebec, Canada
^¶¶ Departments of Pediatrics, Divisions of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
^## Departments of Pediatrics, Divisions of Cardiology, Ochsner Children's Hospital, New Orleans, Louisiana
^_*** Departments of Pediatrics, Divisions of Cardiology, Sanger Clinic, Charlotte, North Carolina
Departments of Pediatrics, Divisions of Cardiology, Sanatorio del Salvador, Argüello, Cordoba, Argentina
Departments of Pediatrics, Divisions of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
Departments of Pediatrics, Divisions of Cardiology, Children's Heart Center, Seattle, Washington
^|||||| Departments of Pediatrics, Divisions of Cardiology, Children's Hospital of New York-Presbyterian, New York, New York
^¶¶¶ Departments of Pediatrics, Divisions of Cardiology, University of Kentucky, Lexington, Kentucky
^### Departments of Pediatrics, Divisions of Cardiology, Georg-August-University, Göttingen, Germany
^_**** Departments of Pediatrics, Divisions of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Manuscript received August 4, 2008; revised manuscript received November 12, 2008, accepted November 16, 2008.

^_* Reprint requests and correspondence: Dr. Kathryn K. Collins, The Children's Hospital, Section of Cardiology/B100, 13123 E. 16th Avenue, Aurora, Colorado 80045 (Email: Collins.kathryn{at}tchden.org).

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.

Key Words: junctional ectopic tachycardia • arrhythmia • amiodarone • radiofrequency catheter ablation • cryoablation • child

Abbreviations and Acronyms   AJR = accelerated junctional rhythm   JET = junctional ectopic tachycardia   RF = radiofrequency

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